Multiple studies have shown that antidepressants boosting serotonin levels can affect sexual function and drive.

But can they also keep Cupid's arrow from reaching the heart?

It's a possibility, say psychologists and psychiatrists at The University of Texas Health Science Center at Houston.

But complicating the issue is that symptoms of depression already include a lack of interest in romance and sex while medication could actually help revive interest and the ability to fall in love, if not sexual function.

In other words, you might be more romantically inclined but have trouble moving that romance to the bedroom.

Physicians say that diminished sexual desire or trouble achieving orgasm may be acceptable tradeoffs, at least short-term, to get out from under the cloud of depression. Treatment for clinical depression usually lasts at least four months.

"Depression can cause a decrease in libido, or interest in sex, and maybe in arousal and orgasm," says Camille Lloyd, PhD, professor in the Department of Psychiatry and Behavioral Sciences at The University of Texas Medical School at Houston and director of the student counseling service.

"If a person is suffering from a biochemical depression, an antidepressant could help overall functioning, so the ability to have romance and fall in love would improve," says Kenneth J. Krajewski, MD, associate professor of psychiatry and behavioral science at the UT Medical School.

Single people might be willing to get out and look for love if their depression lifts.

"When people feel better about themselves, they're better able to go out and find someone to have a relationship with," says Katherine A. Cowan, MD, associate professor of psychiatry and behavioral science at the medical school. "They can tolerate the potential for rejection. And since they're not morose and dwelling on their depression, they might be interesting enough to get someone's attention."

Likewise, teens taking antidepressants might find it easier to make friends, including the romantic kind. "If the treatment for depression and anxiety is successful, they could have greater success with interpersonal relationships," says child/adolescent psychiatrist and visiting professor Ann E. Saunders. "If they're not as irritable, they're better able to tolerate the little things that might bug them otherwise."

A Chemical Mess

An estimated 18.8 million Americans suffer from depression in any one year, according to the National Institutes of Health. It is caused by a biological imbalance of certain neurotransmitters in the brain-serotonin being one of those brain chemicals. Depression can be an inherited biochemical disorder or can be brought on by a life crisis such as the death of a loved one.

Depression is marked by symptoms lasting more than two weeks. They include sadness, hopelessness, pessimism, worthlessness, fatigue, lack of concentration, irritability, suicidal thoughts and loss of interest in things usually enjoyed, including sex.

Psychiatrists usually treat patients with a combination of psychotherapy and medications that increase neurotransmitter activity.

But one popular group of antidepressants, selective serotonin re-uptake inhibitors (SSRIs), can interfere with libido and function, or create anorgasmia, the inability to achieve orgasm, in 30-60 percent of patients. The group includes Prozac, Paxil, Zoloft, Sarafem, Celexa, Lexapro and Luvox, to name a few.

'Great Chemistry'

According to a story published last year in the New York Times, Rutgers anthropologist and author Dr. Helen E. Fisher believes that a decrease in sexual desire and arousal affects a person's ability to fall in love, or at least recognize the feeling of "falling." In other words, if we blunt 'that great chemistry we have together'  with medication, do we even know if we have chemistry together at all?

But Krajewski points out that serotonin medications are boosting low levels of the neurotransmitter into an acceptable range.

"These medications are returning the person to their biological baseline," Krajewski says. "The model is that they have decreased serotonin function and this balances them out. Does that mean people in the normal population have less sexual drive? Maybe, but this is about getting that person back to their baseline."

But if the desire for sex goes away, what effect does that have on the relationship? "A relationship could be damaged if the question 'How about tonight, Honey?' is always met with 'not interested,' "Cowan says.

Fortunately, if a patient finds the sexual side effects too severe, physicians can switch them to another antidepressant such as bupropion (Wellbutrin), which affects the neurotransmitters epinephrine and dopamine more than serotonin. The downside is that bupropion is not as effective as serotonin in relieving anxiety.

Physicians may add bupropion or another medication such as Viagra to minimize function problems. And, the dampening of desire often is only a temporary side effect that goes away on its own with time.

One unexpected bonus, doctors have found, is that SSRIs can help men who have previously experienced problems with premature ejaculation. "Prozac might take the premature out of premature ejaculation," Krajewski says.

UPDATED: 2-11-2005

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