From the Guidelines
Bupropion is generally considered to have the least amount of sexual side effects among all SSRIs, with a significantly lower rate of sexual adverse events compared to fluoxetine or sertraline 1.
Key Points to Consider
- Bupropion had a lower rate of sexual adverse events than fluoxetine or sertraline 1
- Paroxetine had higher rates of sexual dysfunction than fluoxetine, fluvoxamine, nefazodone, or sertraline 1
- Vortioxetine (Trintellix) and Vilazodone (Viibryd) may also be considered as options for patients who are concerned about sexual side effects, although the evidence is not as strong for these medications 1
- Individual responses to medications can vary, and the best approach is to work closely with a healthcare provider to find the most suitable medication and dosage
Medication Options
- Bupropion: may be considered as a first-line option for patients who are concerned about sexual side effects
- Vortioxetine (Trintellix): at a dose of 5-20 mg daily, may be considered as an option for patients who are concerned about sexual side effects
- Vilazodone (Viibryd): at a dose of 20-40 mg daily, may be considered as an option for patients who are concerned about sexual side effects
From the FDA Drug Label
Male and Female Sexual Dysfunction with SSRIs Although changes in sexual desire, sexual performance and sexual satisfaction often occur as manifestations of a psychiatric disorder, they may also be a consequence of pharmacologic treatment. In particular, some evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can cause such untoward sexual experiences Table 5 Adverse EventSertraline Hydrochloride TabletsPlacebo Ejaculation Failure1(Primarily Delayed Ejaculation) 14% 1% Decreased Libido26%1% Table 3 displays the most common sexual adverse reactions in the placebo-controlled MDD studies Preferred TermMalesFemales Placebo N=416 Vilazodone Hydrochloride 20 mg/dayN=122 Vilazodone Hydrochloride40 mg/dayN=417 Placebo N=551 Vilazodone Hydrochloride 20 mg/dayN=166 Vilazodone Hydrochloride40 mg/dayN=561 Abnormal Orgasm* <1% 2% 2% 0% 1% 1% Erectile dysfunction 1% 0% 3% - - - Libido decreased <1% 3% 4% <1% 2% 2% Ejaculation disorder 0% 1% 2% - - -
Comparison of Sexual Side Effects
- Sertraline:
- Ejaculation Failure: 14%
- Decreased Libido: 26%
- Vilazodone:
- Abnormal Orgasm: 2% (males), 1% (females)
- Erectile dysfunction: 3% (males)
- Libido decreased: 4% (males), 2% (females)
- Ejaculation disorder: 2% (males)
Based on the provided data, Vilazodone appears to have a lower incidence of sexual side effects compared to Sertraline. However, it is essential to note that the incidence of sexual side effects can vary depending on the individual patient and the specific context of treatment. 2 3
From the Research
Sexual Side Effects of SSRIs
The studies suggest that all SSRIs can cause sexual side effects, but the frequency and severity may vary between different medications.
- The most common sexual side effects associated with SSRIs include decreased libido, orgasmic disturbances, and erectile dysfunction 4, 5, 6, 7.
- A study comparing the sexual side effects of fluoxetine, paroxetine, and sertraline found that all three medications had similar rates of sexual side effects, with 27% of patients experiencing no adverse effects 4.
- Another study found that fluoxetine and sertraline had similar efficacy and side effects in the treatment of premature ejaculation, with side effects including nausea, headache, and insomnia 8.
Comparison of SSRIs
The studies do not provide a clear answer to which SSRI has the least amount of sexual side effects.
- However, the studies suggest that bupropion, a non-SSRI antidepressant, may have a lower risk of sexual side effects compared to SSRIs 4, 5.
- A study found that 86% of patients treated with bupropion had no adverse sexual effects, and 77% of bupropion-treated patients reported at least one aspect of heightened sexual functioning 4.
- In contrast, SSRIs such as fluoxetine, paroxetine, and sertraline were found to have similar rates of sexual side effects, with around 25-30% of patients experiencing no adverse effects 4, 8.
Real-World Data
Real-world data on SSRI side effects suggests that around 38% of patients experience side effects, with the most common being sexual functioning, sleepiness, and weight gain 6.
- However, only 25% of patients considered these side effects to be "very bothersome" or "extremely bothersome" 6.
- The data also suggests that many patients do not report their side effects to their prescribing physicians, highlighting the need for improved communication and monitoring of side effects 6.