QUESTION: "Dear Ian:

I’m currently on Prozac and really suffering from low desire. My husband is very frustrated, and wants me to go off the drug. I’ve discussed it with my doctor, and we lowered the dosage, and it was very hard emotionally. Anything you suggest?"

ANSWER: At this point in the evolution of our pharmacologically dependent culture, it's well known that a major drawback of anti-depressants such as Prozac and Zoloft is that they often come with serious sexual side effects, namely low desire. (Although it's also well known that these side-effects have never prompted any sort of major study, so the number of actual incidents of low desire is WAY higher than reported. In fact, it's not inaccurate to say that almost everyone on an SSRI, man or woman, is sexually affected in some form or another.) SSRIs (also known as Selective Serotonin Reuptake Inhibitors) increase serotonin levels in the brain, and while this has a demonstrable calming and stabilizing effect on patients, it also seriously impairs desire, arousal and orgasm.

(In fact, in men, low doses of SSRIs can actually help curb premature ejaculation, but have the unfortunate effect of building-up and gradually inhibiting -- great now just when you can finally last longer, you no longer want to have sex! A new premature ejaculation pill from Johnson & Johnson called Dapoxetine is actually a failed SSRI -- it doesn't help with depression, it doesn't impair desire, but it does help with climax-control.)

Those who struggle with depression or anxiety disorder often praise the mood-stabilizing effects of drugs like Prozac, but lament and come to accept the permanent loss of a sex life. And their partners? Depression. Anxiety. Frustration...and often infidelity.In the field of sexual medicine, we are only at the cusp of understanding the relationship between brain and body, and patients are often an unintentional testing-ground. For the last couple of years I've been talking about the role of dopamine, a natural neurotransmitter, in triggering arousal and desire and the role of dopamine-producing drugs such as Wellbutrin (the brand name for bupropion hydrochloride.)

Dopamine is a natual sex-chemical, the "infatuation elixir." Dopamine fuels the chase of sex and makes its achievement all the sweeter. The excitement of dopamine plays a role in sexual compulsion as well as infidelity, and is also produced in addicts and risk-taking athletes, in that it has a relationship to adrenaline. While it's widely known that dopamine plays a role in sexual desire, it's lesser known that psyhciatrists often blend dopamine with SSRIs when their patients lose interest in sex or suffer sexual side effects such inability to reach orgasm.

Many doctors and psychiatrists claim great success when blending an SSRI with Wellbutrin, and this week’s there's a first-person piece in the New York Times Health Section, written by psychiatrist, Dr. Richard A. Friedman.

Viva La Vulva, Dr. Friedman! My only lament is that the article is called "A Pill's Surprises, For Patient and Doctor Alike" but for sex therapists and anthropologists like Helen Fisher, author of "Why We Love," the role of dopamine and the interest in dopamine-producers such as Wellbutrin in face of widespread disinterest by the FDA and medical community alike has been exasperating.

I've personally been pushing for more clinical trials on the efficacy of Wellbutrin in treating low desire, along with the sexual side effects of SSRIS, and maybe an article like Dr. Friedman's will bring more awareness to this important subject. For those of you on SSRIS and suffering from sexual side effects, read this article, and know that drugs aren't the only way to produce dopamine. It's a naturally produced neuro-transmitter that's stimulated when we do new, exciting things, when we engage in novel endeavors both individually and as a couple.

If you're really suffering from low desire, you might want to talk to your doctor about Wellbutrin, but also do some research of your own. And watch out, guys: if you've suffered from premature ejaculation, but have enjoyed the effects of delayed ejaculation rendered by an SSRI, going on Wellbutrin may actually cause you to become quick on the trigger again.