I appreciate your input. To answer your questions, Prozac is the first choice becuase it helps with the PMS as well as the depression; the other SSRI-class antidepressants apparently don't, and all have the libido side effects. Even the generic Prozac didn't really do the job, so she's back on the brand name formulation. She was on a tricyclic antidepressant several years ago and it didn't really do anything for the depression.

I have done web searches, and the only things I've really found suggested experimenting with other SSRI's - wich I just covered - or adding Wellbutrin, which is an MAO inhibitor-type drug. The latter was supposed to help in a significant fraction, but not all, cases. But MAO inhibitors react badly with many other medications, and with my wife's combination the doctor wouldn't recommend it.

Again, herbals or nutrients are not something I'd start without checking on medical advice first. I've thought about getting a second opinion, but honestly her doctor is really very good and I don't think my wife would agree. I hadn't thought about perimenapause; my wife is 39 and so that might be a possibility. Do you know whether there are specific tests for that or is it more a spectrum of symptoms? She has been checked for hypothyroidism, and her results came back normal. Thanks again.

HERE is Edward Bear, coming downstairs now, bump, bump, bump, on the back of his head, behind Christopher Robin...sometimes he feels that there really is another way [of coming downstairs], if only he could stop bumping for a moment and think of it.