I suffer from depression. It’s not the occasionall feeling of the blues that everyone experiences after a breakup or career disappoingment; major depression consists of persistent, severe symptoms like anxiety, fatigue and feelings of emptiness and hopelessness.  Although I wasn’t diagnosed with major depressive disorder until my mid-20s, I’ve dealt with depression my entire life.

I’ve learned to manage my depression with medication and therapy, but it’s still a daily ordeal, with some days being worse than others. It’s when I have those dark days that everything seems like a chore, even sex. My partner, although he is very understanding, has a difficult time when those dark days evolve into weeks, which is sometimes the case. No matter what I do, I cannot bring myself to have sex with him. I just can’t. I have no desire, no interest, and in moments where I force myself to do it for him, I hate it. I can’t have an orgasm, nor does my body even respond to his touch. It’s a numbness and apathy I can’t shake.

I’m not the only person who struggles with this — according to the National Institute of Health, about 6.7% of adults in America experience a major bout of depression each year. Many of these men and women suffer from libido issues when their depression and anxiety are at the helm. Even if they’re not on meds that lower their sex drive — a common side effect — they still feel the effects that these psychological and neurological aspects have on their body.

To learn more about the effect on anxiety and depression on the libido, I spoke with marriage and family therapist, Ashlee Eikelboom, as well as a few women who suffer from these mental illnesses.

Here’s what they had to say:

1. It is difficult to feel desirable when you are depressed.

Depression and anxiety can make someone, women especially, feel ugly, both inside and out. That feeling of unattractiveness can spill over into your sex life and immediately put everything on hold. In order for one to want to be intimate and close to someone else, there has to be a certain level of love for themselves. If their once sunny outlook on their self-worth, physically and mentally, is clouded, the idea of being desirable to another human being goes out the window. When my depression kicks in, the last thing I want to do is have sex,” a woman named Lynne told me. “My self-esteem is non-existent, and getting in the mood is a feat, so I just don’t fight it anymore. If I can’t sell myself on the idea, then I just don’t do it.”

Stubborn feelings of worthlessness affect how someone might not feel sexy to their partner, explained Eikelboom. Further complicating those feelings of being undesirable, is the inability to communicate those feelings out loud.

2. The very act of sex is just not enjoyable.

A key symptom of depression is the inability to activities which once gave us pleasure, which for most of us includes sex. Anxiety, which goes hand in hand with depression, also makes enjoying ourselves difficult.

A 2010 study of pre-menopausal women, age 18 and older, found that for 60% of them, their lowered libido could be directly linked to the stresses in their life. Someone with persistent anxiety is, of course, more prone to stress.”

I suffer from generalized anxiety disorder,” explained Gabrielle, “And I find myself not being able to put away my daily worries and stresses in order to focus on pleasure. I think about what time I can wake up tomorrow so I’m not late for work, or so I can make it to the gym, and go through the day without being sleepy, rather than being in the moment with my partner. I’m too busy and tend to go through the motions. It’s something I’m working on, but there are priorities in my life that take over my mental space and make it impossible to concentrate on sex.

3. Depression and anxiety exacerbate worries about failure.

A telltale sign of anxiety is what’s called “all or nothing thinking,” which means a tendency to view things in extremes. A fear of failure — sexual, professional, in relationships — is a common area for this to occur. And according to Eikelboom, fear of failure can become a self-fulfilling prophecy. “For instance, a man may be overly stressed and anxious and not in the mood to engage with his partner, failing to achieve erection,” she explained. “The next time his partner attempts to engage intercourse, the man may become so preoccupied with the idea that he might ‘fail’ again that he is not able to become aroused as he is so distracted by his worry — thus creating his own ending.

This also goes for women if their unable to reach a climax — they can be made to feel guilty, as if they didn’t rise to the occasion because of something their partner did or didn’t do. Again, it leads to a vicious cycle for a woman, too, as the concern with failure becomes a reoccurring theme.

4. There is the persistent lack of motivation.

With depression comes lack of motivation. Getting out of bed isn’t just a hassle, but something you absolute can’t do. There is no point to getting out of bed and functioning in the world when you’re feeling like that, so why bother? And if one can’t be bothered to get out of bed, how can they be expected to engage in sexual intercourse? “I don’t even want to eat when I’m feeling low,” said Catherine. “The thought of even making a sandwich is exhausting. When that’s the case, not having the motivation to do anything, sex seems like climbing Mount Everest.

5. Simply put: there’s just zero interest in sex.

A study found that more than 70% of unmedicated depressives reported a lack of interest due to their illness. What was also found was that the loss of their libido was far more severe of a side effect than other symptoms that came with their depression.”Now that I’m in my mid-30s and apparently at my sexual peak, there’s very little that can make me NOT in the mood, but my libido comes to a full stop when I’m particularly anxiety-ridden or depressed,” said Amelia. “Hell, everything comes to a full stop. But I’ve definitely noticed that in periods when I’m feeling stressed, overwhelmed and inexplicably depressed, the only place I want to be is in my bed — but rarely to do anything but sleep.”>

Depression and anxiety are serious mental health issues and not just because they can be poisonous to your libido. If you are experiening prolonged feelings of sadness, hopelenssness, apathy, and a lack of interest in sex and other activities you used to enjoy, it’s time to see your doctor. You can find more resources about depression, including a referral service hotline, at the National Alliance on Mental Illness web site.