Wellbutrin Does Not Cause Sexual Side Effects—It May Actually Improve Them
Wellbutrin (bupropion) is fundamentally different from other antidepressants because it has significantly lower rates of sexual dysfunction compared to SSRIs, and in many patients, it may actually enhance sexual function. This makes the question of "reducing" Wellbutrin's sexual side effects somewhat paradoxical—the evidence shows Wellbutrin is the solution, not the problem.
The Evidence on Wellbutrin and Sexual Function
According to the American College of Physicians guidelines, bupropion had a significantly lower rate of sexual adverse events than fluoxetine or sertraline 1. The FDA drug label for Wellbutrin notably lists "increased libido" as a postmarketing adverse event 2, which is the opposite of what occurs with SSRIs.
What the Research Shows
A direct comparison study found striking differences 3:
- 86% of bupropion-treated patients had no adverse sexual effects
- 77% of bupropion-treated patients reported at least one aspect of heightened sexual functioning
- Patients reported significant increases in libido, arousal, orgasm intensity, and orgasm duration beyond premorbid levels
- In contrast, only 27% of SSRI-treated patients had no sexual side effects
A controlled study in healthy men without psychiatric illness confirmed that bupropion 300 mg/day caused no subjective sexual dysfunction and did not affect nocturnal erections 4.
If Sexual Dysfunction Occurs on Wellbutrin
While rare, if a patient experiences sexual dysfunction while taking Wellbutrin, consider these possibilities:
1. The dysfunction may be from depression itself, not the medication
Depression commonly causes sexual dysfunction independent of treatment. Reassess whether depressive symptoms are adequately controlled.
2. Check for drug interactions
The FDA label indicates bupropion inhibits CYP2D6 2. If the patient is taking other medications metabolized by this pathway (SSRIs, certain antipsychotics, beta-blockers), drug interactions could theoretically contribute to dysfunction.
3. Consider comorbid medical conditions
Evaluate for:
- Cardiovascular disease
- Diabetes
- Hypogonadism (check morning testosterone if <300 ng/dL) 5
- Other medications the patient is taking
4. Dose adjustment
While not specifically studied for sexual side effects, if dysfunction is genuinely attributed to bupropion, consider whether the current dose is necessary or if a lower dose maintains antidepressant efficacy.
Using Wellbutrin to Treat SSRI-Induced Sexual Dysfunction
The more clinically relevant question is using bupropion to reverse sexual dysfunction caused by other antidepressants. The evidence here is more limited but promising:
- Studies show bupropion 150 mg twice daily (not once daily) demonstrates benefit when added to SSRIs causing sexual dysfunction 6
- Data from three studies showed significant improvement on rating scale scores (SMD 1.60,95% CI 1.40 to 1.81) 6
- The NCCN Survivorship guidelines note that SSRIs can be used to treat certain sexual dysfunctions (premature ejaculation), while bupropion is positioned as having fewer sexual side effects 5
Practical Algorithm for SSRI-Induced Sexual Dysfunction
- First-line: Add bupropion 150 mg twice daily (not once daily—the evidence supports the higher dose) 6
- For men with erectile dysfunction specifically: Add sildenafil or tadalafil 6
- Consider switching from SSRI to bupropion if depression control allows
Critical Caveat
Bupropion is contraindicated in patients with seizure disorders, eating disorders, or those abruptly discontinuing alcohol or sedatives due to lowered seizure threshold 7, 2. The FDA label notes weak evidence of increased seizure risk 1.
The consumption of alcohol should be minimized or avoided during Wellbutrin treatment due to rare reports of neuropsychiatric events 2.