What Happened to My Sex Life? (cont.)

Still, she says that going off Celexa would be too much of a gamble. "Now, when I snag myself, I can untangle myself quickly and move on."

Another friend of mine, Holly, a self-described divorced Atlanta housewife with two teenage children, started taking Prozac in 1989 when her gynecologist prescribed it for anxiety. "I had two small children at the time, was working full time, and I had just too much to juggle. I noticed a slow but very dramatic change in everything once I was on the Prozac. In one sense, nothing changes, but your reaction to everything changes. I could be stopped in traffic, late to pick up my kids from day care, and in the past, that would cause me a lot of stress; but with the Prozac, I'd just accept the reality and was much, much calmer. You roll with everything. You observe things differently. I'd have a peaceful response to things that in the past would cause me to freak."

But as with Claire, the drug nailed her sex life. "I remember initially on Prozac I had little interest in sex. It really was a nasty side effect. But it was a trade-off: Everything functioned so much more smoothly that I never got too concerned about what it was doing to my sex drive."

With Holly -- who is 48, works out with a personal trainer every week, and is engaged to remarry in the fall -- her libido gradually returned after about a year on the drug. Psychiatrists say some people neutralize the effect the drug has on their sex drive, but it can take months, sometimes years.

Holly noticed something else about the Prozac, something commonly known as "Prozac poop-out." The longer she took the drug, the less effective it seemed to become. In 1992, her gynecologist switched her to Paxil, but that seemed to deaden her much more than the Prozac did -- and not just her sex drive. "My emotions, reactions, feelings, were numbed with the Paxil. Again, though, my sex drive came back but it took time, maybe a year."

Finally, two years ago, Holly went to a psychiatrist who prescribed Celexa. "For the first three weeks, I felt euphoric, almost giddy. Then I came down a little, but I don't feel deadened. I have my emotions back. It still has a negative effect on my sex drive, but at least it's the least of the three drugs."

Everywhere I turned, I heard the same story. The drugs were great, so great that they were worth giving up great sex for. Cassie, a pixieish, freckle-faced, 33-year-old web site developer from San Francisco, told me that a crushing, traumatic divorce two years ago sent her crashing into a downward spiral, and Prozac was the only way out. She credits Prozac with saving her life. For the first year on the drug, her sex drive was minimal, but "who wants to have sex when you're trying to climb back to being yourself again?" In the last year, she said, her body seems to have compensated for the Prozac and her libido appears to be coming back, although she can't say for sure because she's not currently in a relationship.

When I canvassed my male friends on antidepressants about their sex lives, I got a different story. Either these guys are super studs and nothing can deaden their ardor -- or maybe it was an Arnold Schwarzenegger macho-guy thing.

Greg, a 48-year-old television producer (and marathon runner) in Los Angeles, went on Prozac for depression in 1990, but developed chronic insomnia (a common side effect), so he switched to Zoloft a year later. Greg says he doesn't really know whether the SSRI has done anything to his sex drive. Now married and the father of a 2-year-old daughter, he says his interest in sex hasn't dampened, but his frequency is off from what it used to be. "I'm not prowling around as I did when I was 29." Still, Greg says he has no problem getting and keeping an erection, masturbating, and fantasizing. That also might have something to do with his wife's travel schedule: She's away on business for up to two weeks at a time.

Another friend, Todd, a 41-year-old Manhattan media executive who is a drop-dead double for actor/playwright Sam Shepard, underwent a debilitating bout of depression while living overseas two years ago, so bad that he thought he'd have to be hospitalized. His psychiatrist prescribed Effexor, which gradually seemed to lift the dark clouds. Todd isn't sure about what sexual side effects the drug had on him. "I was so depressed, I didn't want to have sex. And with the Effexor, my mood got better, the depression eased, so I think, in that way, the drug probably helped me sexually." Todd weaned himself off the drug and now takes no antidepressants, and he says he hasn't had a relapse.

Welcome to the New Millennium, where the dot-com generation happily chats about IPOs, their nifty Palm VII handhelds, and their accessory-dripping Lincoln Navigator SUVs. RAM size is what's important. Bandwidth is one's calling card. But mention orgasms, and the lattes go cold.

I'm not making light of depression. Surveys variously indicate that as many as one out of three women and one out of eight men will, sometime during their lives, be classified as clinically depressed. And the World Health Organization says that by 2020, depression will top the list of health-related maladies in the developed world, and that severe depression will be the second-greatest cause of disability. It is a real disease; a crushing feeling that the world is closing in on you, that a thick black curtain is crashing down on your life.

Considering the enormous popularity of antidepressant drugs like Prozac, Paxil, and Zoloft, and the drug culture that spawned them and now adores them, it makes sense that modern-day pharmacology has perfected such an effective and profitable pharmaceutical that can pinpoint with awesome accuracy the neurotransmitters and receptor sites that cause depression.

The world's first SSRI, Prozac, was launched in 1986 in Belgium and approved a year later for use in the United States. Since then, about 17 million Americans have taken the cream-and-lettuce-colored capsule. Prozac is the most widely prescribed antidepressant in the world.

Since its introduction, other drugs with similar properties have come down the pike: The most widely known include Paxil, Zoloft, Luvox, Effexor, and Celexa. Each is slightly different in its formulation and, therefore, affects users differently. Effexor, for instance, is not a straight SSRI; it blocks reuptake of not just serotonin, but also norepinephrine and dopamine.


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