Depression is one of the leading causes of disability for Americans ages 14 to 44. Many men and women with depression have little or no sexual desire. That can put a tremendous strain on relationships.

The brain controls sexual drive, arousal, and sexual function through the release of hormones and nerve impulses. Depression stems from a chemical imbalance in the brain and that imbalance can interfere with those controls. Depression can affect the ability to enjoy sex or perform sexually; decrease libido and cause erectile dysfunction (ED).

If you are clinically depressed and experiencing sexual problems, talking openly with your doctor can help. Without knowing there's a sexual problem, your doctor can't do anything.

Antidepressants are one way to treat depression, but unfortunately a side effect can be sexual dysfunction. Can you say Catch-22? Decreased libido is most often reported, but patients also say antidepressants cause ED and inhibit sexual pleasure. Some people also report trouble reaching orgasm.

Experts advise not stopping depression treatment out of fear your sex drive will suffer. Depression itself can hurt relationships and may cause loved ones to take these problems personally. Whatever is happening with your sex life, it's important to treat depression first and address sexual side effects later.

On the positive side, antidepressant side effects can be tied to the dose prescribed. Sometimes simply lowering the dose will treat the depression without blocking sexual desire. But don't tweak the dose yourself. There are also new antidepressants that leave your sex drive alone. Talk with your doctor about options.

Another option is St. John’s wort, an herbal remedy, as a treatment for mild to moderate depression. According to a recent study, it helped patients’ depression without curbing libido. But many experts still stand by antidepressants as the best way to manage chronic depression. If you take any herbal remedy, tell your doctor so he or she can watch for drug interactions. And unlike prescription drugs, the U.S. Food and Drug Administration doesn't require safety and efficacy tests of herbal products and supplements.

It can be easier to cope with sexual problems if you discuss your depression with your doctor and partner. It can be difficult to talk about, but if your partner understands the issue rests with depression and not the relationship, he or she will be better able to provide support. Sexual problems tend to go away as the depression starts to subside. Renewed interest in sex may be the first sign of recovery.

Stacy Lloyd is a writer and video producer in Phoenix, Arizona. A former television news journalist, she covered stories around the world. Currently, she produces corporate and non-profit videos and broadcast programming.