Bipolar Disorder and Sex Drive: What the Studies Actually Show

Searching bipolar and sex drive brings one honest answer: the phase decides, and remission still carries a counted rate. In 132 people with bipolar I in remission, 42.4% scored in the dysfunction range against 16.4% of controls (odds ratio 3.67, 95% CI 1.55 to 8.67). In 45 people in a depressive episode, 91% did. In 80 people in outpatient care, the people with more manic or mixed episodes were less likely to report loss of desire, while subthreshold depressive symptoms raised the odds on the interest items by 20%. A 2026 review of 37 studies and 8,724 people found desire the most affected domain, in a range of 14% to 91%.

What each phase of the illness did to the counted scores

Phase	Study	Who	What was counted
Depressive episode	Malik 2023	45 people, Hamilton Depression scores above 18	91% in the dysfunction range; women worse than men on the desire items
Manic or mixed episodes	Dargél 2022; Elkhiat 2018	80 outpatients; 60 people in remission	More such episodes meant a lower likelihood of libido loss; manic symptoms correlated with higher function in men
Remission, bipolar I	Socorro-Casqueiro 2026	132 people, 61 controls	42.4% against 16.4% of controls
Euthymia on mood stabilizers only	García-Blanco 2020	114 people, four medication groups	Lithium alone worse on desire than anticonvulsants alone
Euthymia, men only	Lagha 2025	60 men, strict mood cut-offs	68% in the dysfunction range, tied to admissions and depressive-episode count

Sources: Malik et al. 2023 (PMID 38361839); Dargél et al. 2022 (PMID 36000440); Elkhiat et al. 2018 (PMID 30033193); Socorro-Casqueiro et al. 2026 (PMID 39083567); García-Blanco et al. 2020 (PMID 32139195); Lagha et al. 2025 (PMID 38824047). All cross-sectional.

Is it the bipolar, the phase, or the medication?

You search because something has moved, and three suspects walk in with you: the illness, the phase you are standing in today, and the pills on the counter. The counted studies separate them only partly. The phase moves the score in both directions. In 45 people in acute bipolar depression, 91% scored in the dysfunction range (Malik and colleagues, 2023). In 80 people in outpatient care, more mixed, hypomanic and manic episodes went with a lower likelihood of losing desire (Dargél and colleagues, 2022). In 60 people in remission, manic symptoms correlated with higher function in the men (Elkhiat and colleagues, 2018), and five people interviewed for a qualitative pilot described higher drive in mania and low drive in depression (Krogh and colleagues, 2023).

Remission keeps a rate well above controls, so a settled mood chart does not clear the score (Socorro-Casqueiro and colleagues, 2026; Lagha and colleagues, 2025). The medication is a second layer, measured in people who are already stable, which is why our pages on lithium and sex drive and lamotrigine and sex drive read differently from the depression literature. If your low stretches into weeks, depression and low libido covers the overlap.

Remission is not the same as a full tank

Socorro-Casqueiro and colleagues (2026) took 132 people with bipolar I disorder in symptomatic remission from one outpatient clinic and set them against 61 healthy controls on the Arizona Sexual Experience Scale. 42.4% of the bipolar group scored in the dysfunction range, against 16.4% of controls, an odds ratio of 3.67 (95% CI 1.55 to 8.67, p = 0.003). That score was associated with being a woman (p = 0.001), older age (p = 0.003) and a longer duration of untreated illness (p = 0.010), and those people had worse quality-of-life scores in every domain. One clinic, cross-sectional, remission defined by the study's own criteria.

The illness burden carries much of it. Lagha and colleagues (2025) required a Young Mania Rating Scale score under 8 and a Hamilton Depression score of 7 or below in 60 men, and 68% still scored in the dysfunction range, with admissions for a mood relapse carrying an adjusted odds ratio of 1.259 (95% CI 1.046 to 1.546). Dargél and colleagues (2022) found the odds of a sexual problem doubling per suicide attempt (adjusted OR 2.01, 95% CI 1.23 to 3.55), rising 60% per hospitalization, and longer illness duration tied to finishing-phase and overall problems. Subthreshold depressive scores raised the odds on interest and frequency by 20% and on the finishing phase by up to 60%.

Namli and colleagues (2018) found a quieter pattern in 50 people in remission against 50 controls: 50% against 48.8% crossed the cut-off for a sexual problem (p = 0.013), near-identical totals, while the women with bipolar disorder scored worse on dissatisfaction, communication and the finishing-phase subscales. Cañada and colleagues (2026) gathered 37 naturalistic studies covering 8,724 people and found a range of 14% to 91%, desire the domain most often affected, poorer function and satisfaction against controls, and worse quality of life and psychosocial functioning in the dysfunction range. Phases sit mixed inside that range, which is why our pages on low libido in women and low libido in men split the question sex by sex.

Depression flattens it, mania raises it

Malik and colleagues (2023) counted 45 people aged 18 to 59 in moderate to severe acute bipolar depression, all with Hamilton Depression scores above 18 and a mean score of 27.93 with a standard deviation of 8.035. Sexual problems turned up in 91% of the group. The women scored worse than the men on desire and frequency (t = 2.229, p = 0.031), desire and interest (t = 2.448, p = 0.019), the finishing phase (t = 2.974, p = 0.005) and the CSFQ-14 total (t = 2.946, p = 0.005). Hospital-based, 45 people, no healthy comparison group.

The mood scores move in step with the sexual score. Sørensen and colleagues (2017) surveyed 61 women: 54% reported sexual distress and 39% were not satisfied, better function was associated with higher mania scores, and higher depression scores went with more distress. Those women were more sexually distressed than Danish women in the general population, and their rate of impaired function was no higher. Elkhiat and colleagues (2018) found depressive scores correlated adversely with every item on the women's index except pain (r = 0.342 to 0.680, p from 0.001 to 0.065), manic symptoms correlated with higher function in the men (r = 0.414, p = .023), and the women's pain item mean ran higher than controls, 3.6 against 3.4 (p = .036).

Five people described the swing from inside it (Krogh and colleagues, 2023). Drive rose in mania, and for some that meant more sexual interactions, described as joyful with no shame attached. In depression the three women reported low drive; the two men described drive that did not drop, alongside a more self-destructive way of engaging in sex. A review of 27 articles (Kopeykina and colleagues, 2016) found more risky sexual behaviour during manic episodes, more sexual problems during depressive episodes and lower satisfaction in couples, and the authors warn that hypersexuality has no consistent definition in this literature. Krantz and colleagues (2018) followed 413 youth for a mean of 9.7 years and found hypomanic scores temporally associated with the greatest risk for sexual risk behaviour; Dvorak and colleagues (2013) surveyed 595 young adults and linked risk for mania to more frequent risky sex, only among those low in self-control.

The medication layer

García-Blanco and colleagues (2020) studied 114 people in euthymia for at least 6 months, all on mood stabilizers alone, in four groups: lithium alone, anticonvulsants alone (valproate or lamotrigine), lithium plus anticonvulsants, and lithium plus benzodiazepines. The anticonvulsant-alone group had better total sexual function scores than the lithium-alone group and the lithium plus benzodiazepines group. Against the anticonvulsant group, both lithium groups had worse desire, the lithium-alone group had worse physical-response scores, and the two combination groups had worse finishing-phase scores. Being a woman and older age were associated with worse total and all subscale scores. The authors conclude that anticonvulsants in monotherapy carried the least negative effect, and nobody in the study took antipsychotics or antidepressants.

Grover and colleagues (2014) found 37 of 100 clinically stable people on lithium in the dysfunction range, that group older, lower on functioning, reporting more adverse effects and adhering less well; the lithium and sex drive page charts that study in full. In 63 clinically stable people on valproate alone (Grover and colleagues, 2021), 28.6% scored in the dysfunction range, desire problems ran from 13.33% to 35.41% in men and 6.66% to 46.66% in women depending on the cut-off, and erection problems appeared in 13.33% to 31.25% of the men. Ghadirian and colleagues (1992) surveyed 104 people on lithium and found difficulties with sex in 49% of those also taking a benzodiazepine, against 14% on lithium alone and 17% on lithium with other drugs, with no link to blood lithium or prolactin levels.

Some of this travels with the illness. Hou and colleagues (2018) followed 5,150 men newly diagnosed with bipolar disorder, each matched with controls, and found a significantly higher hazard of an erection-problem diagnosis, including in the men who were not on active medication; the abstract prints no hazard values, and those records held no sexual function questionnaire. Dose, timing, switching and adding are your prescriber's calls, weighed against relapse risk. Our pages on Seroquel and sex drive and Abilify and sex drive cover two more of those conversations.

Partners, and the swing itself

Andreasen and colleagues (2025) counted 111 people with bipolar disorder and 74 partners of people with bipolar disorder. Relationship satisfaction differed between the groups, with the partners less satisfied (p = .050), and a general population comparison was more satisfied on each relationship item (p under 0.05). Adjusted for sex, age, mood scores, functioning and stress, the people with bipolar disorder were more satisfied with their sexual life over the last year than the partners (p = .039) and rated a good sexual life as more important (p = .006). More people in both groups rated that year's sex life bad to extremely bad than in the general population: partners 21.1%, the bipolar group 23.4%, general population 16%.

The swing is the thing partners read. Kopeykina and colleagues (2016), reviewing 27 articles, found lower sexual satisfaction tied to the diagnosis in couples where one partner has bipolar disorder, sexual interest varying across the polarities, and a gap in satisfaction between the person with bipolar disorder and the partner. Cañada and colleagues (2022) counted 100 people in remission on mood stabilizers alone: hyperthymic traits predicted higher scores on overall sexual function (OR 1.222, 95% CI 1.073 to 1.431) and on desire (OR 1.164, 95% CI 1.025 to 1.357). The counted satisfaction gap sits on both sides of the bed, and when a partner stops asking for sex picks up that side.

What has been counted, in order

Nobody has counted this question once. The counting runs from a 1992 lithium survey to a 2026 study of people whose mood was stable, and every look in between added a number and a caveat. There is no single rate. The pattern is a swing that follows the phase, a rate that survives remission, and an illness burden measured in admissions and episodes. Read them as a stack of small studies. None of them is a settled answer. Here is what each measured, in order.

Bipolar disorder in the studies: what each measured, and what it says about desire.

Study	Design	Who	Finding	What it says about desire
Cañada 2026	Systematic review	37 studies, 8,724 people	14% to 91%, desire the most affected domain	Naturalistic studies only, phases mixed together
Socorro-Casqueiro 2026	Cross-sectional with controls	132 people in remission	42.4% against 16.4%	Remission does not clear it
Dargél 2022	Cross-sectional with controls	80 people	Odds doubled per suicide attempt; more manic episodes meant less libido loss	Illness burden on top of phase
Malik 2023	Cross-sectional	45 people in bipolar depression	91%	No control group
Sørensen 2017	Survey	61 women	54% distress, better function with mania scores	Distress and function are different things
Elkhiat 2018	Cross-sectional with controls	60 people in remission	Manic symptoms tracked higher function in men; women's items tracked depression scores	The same phase reads differently by sex
García-Blanco 2020	Cross-sectional	114 euthymic people on mood stabilizers only	Lithium alone worse on desire	Medication is a second layer
Hou 2018	Nationwide cohort	5,150 men	Higher erection-problem hazard even without medication	No desire measure at all

What actually helps, graded honestly

Mood stability carries the most numbers. In 45 people seen during a depressive episode, sexual problems were found in 91% (Malik and colleagues, 2023). In 132 people with bipolar I in symptomatic remission, 42.4% scored in the dysfunction range against 16.4% of 61 healthy controls (Socorro-Casqueiro and colleagues, 2026). Remission narrows that gap. It does not close it.

Episode history tracks the score too. In 60 men in the euthymic phase, admissions for a mood relapse and the count of depressive episodes both moved the Arizona Sexual Experience Scale score (Lagha and colleagues, 2025), with an adjusted odds ratio of 1.259 (95% CI 1.046 to 1.546) per admission. Dargél and colleagues (2022) found odds up 60% for every extra hospitalization in 80 people. That is a reason to keep the plan your prescriber set.

The medication question has counted comparisons behind it. In 114 people in euthymia taking only mood stabilizers, anticonvulsants alone scored best on desire and lithium alone scored worse (García-Blanco and colleagues, 2020). Grover and colleagues reported 37 of 100 stable people on lithium in the dysfunction range, then 28.6% of 63 people on valproate alone. Changing anything is your prescriber's call. Our page on lithium and sex drive and our page on lamotrigine and sex drive carry the detail.

The last lever is saying it out loud, and it is free. The 2026 systematic review of 37 studies covering 8,724 people found desire was the domain most often affected, which is a case for raising it at every visit without waiting to be asked. Partners carry their own side: across 111 people with bipolar disorder and 74 partners, the partners reported lower relationship satisfaction (Andreasen and colleagues, 2025). If an antidepressant is part of your plan, what helps an SSRI libido drop is written for that conversation.

What to bring to your doctor

Bring the pattern. A general account of how you feel gives a prescriber less to act on. A prescriber can act on a timeline and a drug name. Write these five lines down the night before, and take the bottle of anything you take.

1. Which phase you are in now, and which phase the change arrived in. The counted rates differ enormously between a depressive episode (91% in Malik and colleagues, 2023) and remission (42.4% in Socorro-Casqueiro and colleagues, 2026), and manic phases push desire the other way (Elkhiat and colleagues, 2018; Dargél and colleagues, 2022).
2. Which items changed: desire, the physical response, finishing, or erections. Desire was the domain most often affected in the 37-study review (Cañada and colleagues, 2026), and the medication studies report by domain (García-Blanco and colleagues, 2020; Grover and colleagues, 2021).
3. The number of admissions and episodes you remember, because the counted scores tracked them: an adjusted odds ratio of 1.259 (95% CI 1.046 to 1.546) per admission in 60 men (Lagha and colleagues, 2025), and odds up 60% per hospitalization in 80 people (Dargél and colleagues, 2022).
4. Whether a medication question fits, asked as a question. My desire dropped after this drug started, and what are the options that carry less sexual burden, given that anticonvulsants alone scored best on desire in 114 people (García-Blanco and colleagues, 2020)?
5. The supplement question, bottle in hand. Read the label out loud in the room, including the blood-pressure, heart and kidney wording, and ask for a plain yes or no.

The everyday levers, and where a botanical fits

Start with who this section is not for. Blood-pressure medication, heart disease, kidney disease and lung disease are common, and they are exactly what NUUD's own label warns about: avoid use if you are on blood pressure medication, have cardiovascular, renal, or pulmonary conditions, or if you are sensitive to any of the ingredients. If that sentence describes you, it is the answer. Talk to your doctor first and bring the label.

A few ordinary things move desire in most people, and the free ones do more work than the internet admits.

• Sleep, in quantity and on a schedule. In an illness where a short night can tip a mood, sleep debt does double damage, and sleep, libido and testosterone covers the mechanism.
• Movement you can keep up, on steady days as well as good ones. Exercise and libido covers the wider picture.
• Keeping the plan your prescriber set, since admissions and episode counts are what tracked the scores in both burden studies.
• Time with a partner, or on your own, with nothing expected at the end.
• A botanical supplement, if you want one, as the smallest lever on this list.

NUUD is a botanical supplement built around desire in general. It does nothing for bipolar disorder, for mood episodes, for lithium or for any other mood stabilizer, no interaction study exists for this formula and any psychiatric medication, and it has no role in managing any medical condition. The formula is anchored by the NUUD Mushroom Complex™, with Muira Puama, Boiled Rehmannia Root, Tribulus Terrestris, and Piper Nigrum for absorption, on a timeline of roughly 30 to 60 minutes. If you take blood-pressure medication or have a heart, kidney or lung condition, the label says no, and your doctor decides the rest. If your doctor has read that label and has no objection, that is what our women's libido gummies are for. There is a men's version.

Nothing is wrong with you

Two lazy answers are waiting for you, and both cost time. The first is that this is the illness talking, so there is nothing to do. The numbers say otherwise: 42.4% in remission against 16.4% of controls, 91% during a depressive episode, desire pushed the other way in mania, and lithium alone scoring worse on desire than anticonvulsants alone. Each of those is a place a plan can go. The second answer is that this is the pills, so stop them. No study here supports stopping anything, and the relapse cost shows up in the same data as admissions and episodes. Phase, illness burden and medication all sit on the scale, and all three belong in the next visit. Wanting to want it again is a normal thing to want.

Keep reading

• Lithium and sex drive
• Lamotrigine and sex drive
• Seroquel and sex drive
• Abilify and sex drive
• Depression and low libido
• When a partner stops asking for sex

Frequently asked questions

Does bipolar disorder affect sex drive?
Yes, and the range is wide because the studies differ. A 2026 systematic review of 37 studies covering 8,724 people put the share scoring in the dysfunction range between 14% and 91%, with desire the domain most often affected. In 132 people with bipolar I in remission, 42.4% scored in that range against 16.4% of 61 controls (odds ratio 3.67, 95% CI 1.55 to 8.67). In 45 people during a depressive episode the figure was 91%. Every one of these is an observational count.

Does mania increase sex drive?
Sometimes, and the studies split. Elkhiat and colleagues (2018) found manic symptoms associated with higher sexual function in men during remission. Krogh and colleagues (2023), in five people, described a higher drive during manic episodes. Dargél and colleagues (2022) went the other way on loss: people with more mixed or hypomanic and manic episodes were less likely to report loss of desire. Kopeykina and colleagues, reviewing 27 articles, reported more risky sexual behaviour during manic episodes. Hypersexuality is the literature's own label.

Does bipolar depression lower sex drive?
Yes, on every count. In 45 people with moderate to severe bipolar depression, sexual problems were found in 91%, and the women scored worse than the men on desire and frequency items (Malik and colleagues, 2023). Sørensen and colleagues (2017) found depressive scores tracked more sexual distress in 61 women. Elkhiat and colleagues (2018) found depressive scores correlated with the women's function items. Dargél and colleagues (2022) found subthreshold depressive scores raised the odds on interest items by 20%.

Do mood stabilizers lower sex drive?
Some carry more of it than others, and the illness carries its own share. In 114 people in euthymia taking only mood stabilizers, lithium alone carried worse desire scores than anticonvulsants alone (García-Blanco and colleagues, 2020). Grover and colleagues reported 37 of 100 stable people on lithium in the dysfunction range, and 28.6% of 63 people on valproate alone. Hou and colleagues (2018), in 5,150 men, found a higher hazard of an erection-problem diagnosis than controls even without medication. Do not stop anything on your own.

Can I take a botanical supplement with bipolar medication?
Ask your prescriber first, and bring the label. It says to avoid use if you are on blood pressure medication, have cardiovascular, renal, or pulmonary conditions, or if you are sensitive to any of the ingredients. No interaction study exists for this formula with any psychiatric medication, so nobody can promise a safe pairing. NUUD is a botanical supplement built around desire in general. It does nothing for bipolar disorder, for mood episodes, for lithium, or for any other mood stabilizer.

References

1. Sørensen T, Giraldi A, Vinberg M. Sexual distress and quality of life among women with bipolar disorder. International journal of bipolar disorders. 2017;5(1):29. https://pubmed.ncbi.nlm.nih.gov/28589489/
2. Namli Z, Karakuş G, Tamam L. Assessment of Dyadic Adjustment and Sexual Functions in Patients with Bipolar Disorder. Noro psikiyatri arsivi. 2018;55(2):171-176. https://pubmed.ncbi.nlm.nih.gov/30057460/
3. Cañada Y, García-Blanco A, García-Portilla MP, et al. Affective temperaments and sexual functioning in euthymic patients with bipolar disorder. Journal of psychiatric research. 2022;146:201-209. https://pubmed.ncbi.nlm.nih.gov/35007941/
4. Hou PH, Mao FC, Chang GR, Huang MW, Wang YT, Huang SS. Newly Diagnosed Bipolar Disorder and the Subsequent Risk of Erectile Dysfunction: A Nationwide Cohort Study. The journal of sexual medicine. 2018;15(2):183-191. https://pubmed.ncbi.nlm.nih.gov/29425665/
5. Dargél AA, Mosconi E, Volant S, Taieb D, Brenot P. Sexual dysfunction among males and females with bipolar disorder and healthy subjects: The burden of illness severity. Bipolar disorders. 2022;24(6):637-646. https://pubmed.ncbi.nlm.nih.gov/36000440/
6. Malik G, Mishra P, Chaurasia N, Garg S. Sexual dysfunction in bipolar depression: Gender differences. Journal of family medicine and primary care. 2023;12(12):3356-3361. https://pubmed.ncbi.nlm.nih.gov/38361839/
7. Socorro-Casqueiro J, Almeida V, Léda-Rêgo G, et al. Sexual function in patients with bipolar disorder type I evaluated in symptomatic remission: a cross-sectional study. Trends in psychiatry and psychotherapy. 2026;48:e20230778. https://pubmed.ncbi.nlm.nih.gov/39083567/
8. Kopeykina I, Kim HJ, Khatun T, et al. Hypersexuality and couple relationships in bipolar disorder: A review. Journal of affective disorders. 2016;195:1-14. https://pubmed.ncbi.nlm.nih.gov/26851616/
9. Elkhiat YI, Abo Seif AF, Khalil MA, GamalEl Din SF, Hassan NS. Sexual Functions in Male and Female Patients With Bipolar Disorder During Remission. The journal of sexual medicine. 2018;15(8):1111-1116. https://pubmed.ncbi.nlm.nih.gov/30033193/
10. Cañada Y, Navalon P, Zazula R, et al. Sexual dysfunction in bipolar disorder: A systematic review. European neuropsychopharmacology : the journal of the European College of Neuropsychopharmacology. 2026;109:112827. https://pubmed.ncbi.nlm.nih.gov/41930708/
11. Grover S, Mehdi A, Kumar A, Chakrabarti S, Avasthi A. Sexual dysfunction in clinically stable patients with bipolar disorder receiving valproate. Indian journal of psychiatry. 2021;63(4):366-371. https://pubmed.ncbi.nlm.nih.gov/34456349/
12. Lagha M, Homri W, Dhaouadi N, Rouached S. Factors associated with sexual dysfunction in patients with bipolar disorder. L'Encephale. 2025;51(3):249-254. https://pubmed.ncbi.nlm.nih.gov/38824047/
13. Andreasen LH, Sandeman VD, Krogh HB, et al. Relationship and sexual satisfaction among patients with bipolar disorder and partners. Sexual medicine. 2025;13(3):qfaf051. https://pubmed.ncbi.nlm.nih.gov/40697429/
14. Grover S, Ghosh A, Sarkar S, Chakrabarti S, Avasthi A. Sexual dysfunction in clinically stable patients with bipolar disorder receiving lithium. Journal of clinical psychopharmacology. 2014;34(4):475-82. https://pubmed.ncbi.nlm.nih.gov/24781439/
15. García-Blanco A, García-Portilla MP, Fuente-Tomás L, et al. Sexual Dysfunction and Mood Stabilizers in Long-Term Stable Patients With Bipolar Disorder. The journal of sexual medicine. 2020;17(5):930-940. https://pubmed.ncbi.nlm.nih.gov/32139195/
16. Krantz M, Goldstein T, Rooks B, et al. Sexual Risk Behavior Among Youth With Bipolar Disorder: Identifying Demographic and Clinical Risk Factors. Journal of the American Academy of Child and Adolescent Psychiatry. 2018;57(2):118-124. https://pubmed.ncbi.nlm.nih.gov/29413144/
17. Herder T, Spoelstra SK, Peters AWM, Knegtering H. Sexual dysfunction related to psychiatric disorders: a systematic review. The journal of sexual medicine. 2023;20(7):965-976. https://pubmed.ncbi.nlm.nih.gov/37279603/
18. Krogh HB, Vinberg M, Mortensen GL, Skakke D, Nielsen D, Giraldi A. Bipolar disorder and sexuality: a preliminary qualitative pilot study. International journal of bipolar disorders. 2023;11(1):5. https://pubmed.ncbi.nlm.nih.gov/36735118/
19. Dvorak RD, Wray TB, Kuvaas NJ, Kilwein TM. Mania and sexual risk: associations with behavioral self-regulation. Journal of affective disorders. 2013;150(3):1076-81. https://pubmed.ncbi.nlm.nih.gov/23721925/
20. Ghadirian AM, Annable L, Bélanger MC. Lithium, benzodiazepines, and sexual function in bipolar patients. The American journal of psychiatry. 1992;149(6):801-5. https://pubmed.ncbi.nlm.nih.gov/1590497/

This article is for general education and is not medical advice. Bipolar disorder is a medical condition that only a licensed clinician can diagnose and manage. NUUD is a botanical supplement and has no role in diagnosing, treating, curing, or preventing it or any other disease, and these statements have not been evaluated by the Food and Drug Administration. Talk with your doctor before starting any new supplement, and do not stop or change any medication without your doctor.