Sex, drugs and depression: what your doctor needs to know

For many of us, a visit to the doctor is a source of anxiety: what do my blood results mean? Will my doctor think this lump is cancer? The physical exam can make us vulnerable and may involve some slight discomfort, so we may shower, shave and put on better than average clothes before going to our physical exam to minimize this discomfort.

However, it’s the intimate discussions – whether it’s crushing depression, increasing alcohol consumption or sexual problems – when our palms really start to sweat. These difficult discussions can be more comfortable and productive when we know what to expect.


Most people don’t volunteer their sexual history, so be prepared to have your doctor ask you a few questions directly as part of your comprehensive exam. Doctors ask all patients about their sexual history, regardless of age, gender and marital status. (This blog post has some tips for talking about sex with your doctor if you’re in the LGBTQ+ community.)

As a psychiatrist, I regularly discuss sexual activity with my patients because mood swings, substances, and many medications can affect sexual functioning. For example, the most commonly prescribed class of antidepressants, selective serotonin reuptake inhibitors (SSRIs), are more likely to lower libido than to treat depression. (They get a remission in about 30% of patients – but they cause sexual dysfunction in 60% to 70%.)

What your doctor may ask you: The Five Pspartners (number and sex), practices (what type of sexual contact), protection (method of contraception), history of sexually transmitted infections (STIs), and pregnancy. Your doctor may also ask you about medications or supplements that may affect sex drive.

What your doctor needs to know: Your doctor should understand your risk of getting an STI, including any risky behavior or substance use. In addition, your doctor should be informed of any change in libido, problems with orgasm, difficulty maintaining an erection, or delayed ejaculation. This information helps your doctor think about contributing causes, including your hormone levels, medical conditions, and medications.

Substance use

This is another tricky subject, as almost everyone minimizes their substance use. Most people understand that smoking or consuming too much alcohol is not good for them — it’s not a matter of education. In fact, patients may avoid disclosing their use because they don’t want their doctors to “educate” them.

People who use substances often experience shame, one of the strongest negative emotions we can feel, and something people strive to avoid. It is useful to remember the role of your doctor: it is not a question of judging, and certainly not of reprimanding. Assuming you trust your doctor, it can be helpful to think of your doctor as an ally. Together you can think of ways to reduce use (harm reduction) or to stop using completely, when you are ready.

What your doctor may ask you: It is common practice to ask about tobacco, alcohol and illicit drug use. If you drink alcohol, smoke, or use substances, be prepared to have your doctor ask you detailed questions about the amount, frequency, attempts to curb, and cravings.

What your doctor needs to know: The truth! Try to think back to the last week and count the total number of drinks/cigarettes/pills consumed. Also let your doctor know if you are interested in reducing or discontinuing use altogether. Your doctor can work with you to optimize your treatment, whether it’s medication to curb your cravings or connecting you with support groups.

Mental Health

Most primary care clinics systematically screen all patients for depression, and some can also screen for anxiety disorders. If you screen positive, your doctor will almost certainly ask you more questions about your mood, if you suffer from anxiety, and even if you’ve had hallucinations or paranoia. Just because your doctor thinks you’re crazy doesn’t; on the contrary, these symptoms may accompany serious illness and could affect treatment decisions.

What your doctor may ask you: To assess depression, your doctor will ask you questions about your sleep, appetite, interest in activities, feelings of guilt, and any changes in concentration or energy levels. Your doctor will also ask you if you have thought about ending your life. These questions can seem deep and intimate, especially if you came to the doctor for an unrelated complaint, such as heartburn. However, your doctor asks these questions to better understand the duration and severity of your symptoms in order to make the correct diagnosis. Here too, it is useful to consider your doctor as an ally. If you are concerned that this information may be in your medical record, you can request that this information be marked as sensitive. No one is allowed to see your medical records without your permission, unless they are caring for you.

What your doctor needs to know: Sometimes depressed mood and anxiety can be linked to an underlying condition such as heart, lung or thyroid problems. Mention any physical symptoms you have noticed, even if they seem unrelated. If this is your first episode of anxiety or depression, think about any life events that might be contributing (such as a recent breakup, job loss, or moving house) as this may help your doctor to differentiate between an adjustment disorder and a major depressive episode. Talk about your coffee habits and alcohol consumption, which can affect sleep and anxiety.

The bottom line

Sharing the most intimate details of your life with your doctor is understandably nerve-wracking. Rest assured that your doctor will keep this information confidential unless there is a risk that you could seriously injure yourself or others. It helps to realize that doctors talk about sex, substances, and mental health with almost all of their patients, and they’ll meet you where you are. Try to relax, breathe deeply and remember: the doctor is by your side.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of the last revision or update of all articles. Nothing on this site, regardless of date, should ever be used as a substitute for direct medical advice from your physician or other qualified clinician.

About Michael Brafford

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