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A problem I don't hear enough about is the impact of psychiatric medications on peoples' sex life. I'd like to hear more because I think discomfort around the subject keeps people from voicing their real concerns. Let's admit it: sex is an important part of life.

Psychiatric medications can reduce sexual desire in both women and men. Another problem for men may be difficulty achieving or maintaining an erection. Antidepressants are most notorious for this, particular the group called Selective Serotonin Reuptake Inhibitors (SSRIs). These side effects are also seen with antipsychotic medications that raise the level of a hormone called prolactin.

What should you do if you suspect that your meds are getting in the way of your love life? The first step is to recognize your right to a satisfying sex life, set aside any shyness you may have on the subject, and have a frank discussion with your doctor. You may want to consider other causes for the problem. Conditions such as depression and schizophrenia decrease sex drive in some people, but treatment may improve things. Many medications prescribed for non-psychiatric conditions (such as high blood pressure) can also cause erectile dysfunction. Drugs and alcohol can contribute to impotence, shrinking testicles and other upsetting physical problems.

If after talking with your doctor, you feel that your psychiatric medication may still be the culprit, there are alternatives. Not all antidepressants decrease sex drive and not all antipsychotics alter prolactin hormone levels. Switching to a different medication may also solve the problem.

Another strategy is to lower the dose of problematic medication and augment it with another one that is free of sexual side effects. Men with erectile problems may be candidates for silendafil (Viagra). Couples may want to consider getting help from a certified sex therapist.

Medications can affect fertility as well. In particular, neuroleptics that raise prolactin also tend to decrease fertility, making it less likely a woman will get pregnant. Some mood stabilizers reduce the effectiveness of birth control pills and thus increase fertility. Either possibility could be desirable or troublesome, depending on your point of view. A good psychiatrist will be willing to talk with you and your doctor about any concerns you may have.

I feel obliged to add: condoms are the best protection (aside from abstinence) from sexually transmitted diseases, and women should see their gynecologist yearly for cancer detection.

Editor's Note: Dr. Bosworth is a Clinical Assistant Professor of Psychiatry at NYU and Associate Director of Inpatient and Emergency Services at Lenox Hill Hospital. She also has a private practice.