Gloom With A View

I'm 36 and my fiancee is 37. We've had a great sex life -- until recently. She began taking Prozac for depression, and it's drastically reduced her sex drive. We hardly have sex anymore (maybe once on weekends, never during the week). I'm sensitive to her needs, offering anything to get her in the mood, but she always refuses. She tells me sexually explicit stories about her pre-Prozac days, and I listen with fascination, disbelief, envy, frustration, and finally, anger. What upsets me most is that she doesn't mind the lack of sex, and says she'd willingly take Prozac for the rest of her life! Now I despair for our future together. How can I get our sex life back on track?

--Sedating Woes

Some women like sex in the morning, some like it in the afternoon, and some like it in the past. Although your fiancee seems poised to reconnect with her virginity after marriage, she is kind enough, these days, to keep sex with you a priority...right up there with dusting the mini-blinds, installing a new blue-flush thingie, and other weekend chores.

In the future, even if a hot evening with her is a night that ends in a really wild handshake, you'll still have the memories -- of her and all those other guys. How thoughtful of her to keep you so well-informed. It's possible she wants to reassure you (and maybe herself, too) that, she's really quite the animal in bed -- just one who happens to be in hibernation until further notice. Then again, maybe she's just cruel, hostile, and violently tacky.

She certainly takes a creative approach to partnership: “I'm happy if I'm happy, and you'll just have to gnaw the bedpost until you pass out from ingesting wood varnish.” Nice! In her defense, her happy pills could be what's keeping her from giving a rat's furry hindquarters about you. Dr. Barbara Bartlik, assistant professor of psychiatry at Weill Medical College of Cornell University, notes that “antidepressant-induced apathy” can be an (infrequent) side effect: “Some of my patients (on antidepressants) will come in and say, ‘I don't work as hard at my job...I'm not as conscientious as I used to be when I was so neurotic.' They're much more likely to blow things off.”

Wave and use flashing lights -- whatever it takes to break through her Prozac fog. Make her understand it's your relationship that's at stake. But, consider where she's coming from: If she thinks nothing of trading her libido for a bottomless bottle of Prozac, imagine what it means to her to live life instead of spending it curled up in a corner weeping. Prozac, like Zoloft and Paxil, among others, is a SSRI -- a selective serotonin reuptake inhibitor -- a drug that basically makes it open bar in the brain for serotonin, a feel-good chemical. Numerous studies report sexual side effects -- libido loss, orgasm issues, and other sex-slayers -- in approximately 50 to 80 percent of SSRI users.

There's a good chance your fiancee got her sunshine-in-a-bottle from her primary-care physician. If so, the doc might not have made her aware of potential sexual side effects, might not have asked whether she was experiencing any, and might not realize many patients are too embarrassed to pipe up if they are. Reassure her that you don't want to be a buzz-kill, but you were hoping a side effect of her getting rid of her depression wouldn't be getting rid of you. (Hey, honey, nothing personal, but I was hoping for an active sex life well into my elder years, and hurdling age 40 without being forced into involuntary celibacy is an important first step.)

Her first step, assuming you can persuade her to care enough to take it, is trotting to the psychiatrist's office to chat about those sexual side effects. Although she probably won't have to choose between you and biochemical bliss, it will take some pharmacological fiddling for her to have both. Dr. Bartlik and Dr. Frederic Quitkin, professor of clinical psychiatry at Columbia University, both suggest that switching to Wellbutrin -- an aminoketone antidepressant that's actually been shown to get the libido hopping -- might be the answer. “Many people who respond to SSRIs respond to Wellbutrin,” says Quitkin. Taking Prozac in combination with Wellbutrin is another possibility both docs suggested. But, “the first thing to do,” says Quitkin, “is to lower the (Prozac) dose either to the point that you don't have sexual side effects or you relapse. Let's say I'm taking 30 milligrams of Prozac, and I feel fine, but I have no libido. How do I do on 20 or 10?” Of course, what works for your fiancee is between her and her shrink. Sadly, her efforts to convince you that “Woman Snoring” is a little-known position from the Kama Sutra don't seem to be doing the trick.