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Depression can cause imbalances in the brain’s neurotransmitters—particularly serotonin, dopamine, and norepinephrine. These chemicals play an important role in regulating sexual desire, arousal, and erectile function. A reduction in these neurotransmitters can lead to difficulty achieving or maintaining an erection. Depression is also associated with lower testosterone levels, a key hormone for sexual function. Low testosterone can lead to decreased libido, fatigue, and difficulty achieving erections. Depression and ED can create a vicious cycle. ED can cause anxiety and embarrassment, which in turn can worsen depression.