Healthy Relationships: Etiquette for touchy subjects.

Dear Mark: I have an interesting question for you. The guy on the treadmill next to me (a good friend) was mentioning that he's been seeing this girl for a while, and things are humming along just great, but there's a little snag: there's no fire in the bedroom. During the course of getting to know each other, it came up that the girl was on antidepressants, which my friend now suspects as the cause of the low-energy physicality they're developing. Everything else is falling into place, but the question is, in the course of discussing where they stand (and bringing up the lack of sex in the developing relationship), should the meds be brought up? My friend suspects that his love interest's low sex-drive is a result of the medication, but wonders about the etiquette of a) bringing up the whole "Why aren't we having more sex?" discussion and b) the appropriateness of bringing up the antidepressants. Good Friend

Dear Good Friend, Tell your friend that if he wants to be in this relationship and really cares for this woman then he has no choice but to bring up the subject. Yes, it can be a touchy subject to bring up. But many things are hard to talk about. Family, religion, sex, money are all hard topics. However, all of them must be broached if a successful relationship is to ensue.

Truthfully, there is no etiquette in these matters. I always urge people to take a risk. Love is nothing if not a risk. Take a deep breath and bring up the subject during a relaxing down time between the two of you. For example, over coffee and the paper on a Sunday morning. Something as non-confrontational as possible. Express your feelings to this person and then say something along the lines of "Because I care for you so much, I want us to be able to have this conversation." This disclaimer of sorts will lessen her anxiety and open her up to have a more frank discussion with you about what is really going on.

For the record, the antidepressants could likely be the cause of her lessened sexual prowess. Many of the drugs in that class, SSRIs (serotonin reuptake inhibitors), which alter one's serotonin levels have the same effect. Serotonin is the chemical in your brain that affects your mood, sometimes called the "happy chemical." It's a complicated combination but, in essence, the way the drugs are constructed many times is that, in order to bring up your serotonin level, something else is blocked. Oftentimes it's our ability to fully experience sexual pleasure. Oftentimes, patients say they masturbate for hours without being able to ejaculate. They want to feel the pleasure in their brains but their bodies can't experience the sensation. Some patients say they want to have sex but just have no physical desire. In either case, the result is less sex. Not a good thing for the person they are sleeping with.

My suggestion to your friend is to have his girlfriend contact his doctor and explain to him the situation. I would also suggest that she ask for a referral to a good psychopharmacologist. Oftentimes, general practitioners know very little about the complexities of these drugs and prescribe whatever drug has been marketed to them by the pharmaceutical rep. This does not mean it is right for the patient. There are a lot of drugs out there. Each one has a different chemical makeup. The purpose for this is to match the different chemical makeup of different prospective users. One drug may cause sexual side effects for one person but the next person will experience no side effects whatsoever. Likewise, one drug could cause you diminished sex drive whereas the next drug could produce no side effects at all. A psychopharmacologist or psychiatrist could consult with her, take a medical inventory, and find a drug that offers her more options such as a better mood and the ability to get it on with her boyfriend. See, you really can have it all!