My husband has been on Prozac for six years now. He always had a low sex drive, but after being diagnosed with clinical depression and given Prozac, he has had no interest whatsoever in sex. I try to be understanding because the alternative would be to go back to constant depression. Does the sex drive ever return in most men? Can antidepressants cause impotence?

Angel

Decreased libido (lowered sex drive or lack of sexual desire) and impotence (erectile dysfunction) have both been reported as side effects of Prozac, although decreased libido is more commonly reported than is impotence. Although I've heard of some medication side effects such as nausea subsiding as the body adjusts to the drug, I've not heard of libido increasing while someone is still on a drug that appears to suppress the sex drive. (I must acknowledge, though, that as a clinical psychologist I don't prescribe medication. You may want to address these questions to your pharmacist or your husband's physician.)

For more information about possible adverse effects of Prozac and other psychiatric medications, you and your husband might read psychiatrist Peter Breggin's books Talking Back to Prozac and Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Medications. If your husband decides to stop taking Prozac to see if his sexual desire and sexual functioning improve, I'd definitely recommend he read the latter book (co-authored with David Cohen), which discusses withdrawal responses and rebound effects some people experience when discontinuing or decreasing psychiatric medications, particularly those they have been on for a long time. Such discontinuation is best done gradually and under medical supervision, according to Breggin.

You don't mention whether your husband has been in psychotherapy for his depression or sexual problems. Good psychotherapy can be effective in alleviating even serious depression without psychiatric drugs. If your husband hasn't been in therapy -- if, for instance, his Prozac is prescribed by his primary care physician or a psychiatrist who doesn't have much training in psychotherapy -- he might want to give it a try. Marital therapy (which could include some sex therapy if helpful) might also benefit both of you in addressing any psychological issues related to his depression and sexual problems.