From the Guidelines
Yes, adding bupropion (Wellbutrin) to citalopram (Celexa) can help minimize sexual side effects associated with SSRI use. Bupropion is commonly used as an adjunctive treatment specifically to counteract SSRI-induced sexual dysfunction, which affects approximately 30-70% of patients taking medications like citalopram. Typically, bupropion is added at doses of 150-300 mg daily (usually starting at 150 mg daily and potentially increasing to 150 mg twice daily if needed) 1. The full effect may take 1-2 weeks to develop. This combination works because bupropion has a different mechanism of action than SSRIs - it primarily affects dopamine and norepinephrine rather than serotonin. By increasing dopaminergic activity, which plays an important role in sexual desire and function, bupropion can help restore sexual interest and performance while maintaining the antidepressant benefits of citalopram. Some key points to consider when using this combination include:
- Monitoring for increased risk of side effects such as anxiety, insomnia, or elevated blood pressure 1
- Avoiding use in patients with seizure disorders or eating disorders due to bupropion's potential to lower seizure threshold 1
- Being aware of the potential for serotonin syndrome, a serious condition that can occur with the simultaneous use of multiple serotonergic drugs 1
- Considering the risk of suicidal ideation, particularly in adolescents and men with a co-morbid depressive disorder 1. It's essential to weigh these considerations against the potential benefits of adding bupropion to citalopram for managing sexual side effects, and to closely monitor patients for any adverse effects.
From the Research
Minimizing Sexual Side Effects of SSRIs with Bupropion
- Adding Bupropion (Wellbutrin) to Citalopram (Celexa) may help minimize sexual side effects associated with Selective Serotonin Reuptake Inhibitor (SSRI) use, as suggested by several studies 2, 3, 4.
- A study published in the Journal of sex & marital therapy found that bupropion SR was effective in treating SSRI-induced sexual side effects, with global response rates of 46% for women and 75% for men 2.
- Another study published in Biological psychiatry reviewed the literature on combining bupropion with SSRIs or SNRIs and found that controlled and open-label studies support the effectiveness of bupropion in reversing antidepressant-associated sexual dysfunction 3.
- A review published in the Journal of psychopharmacology found that there is limited, mainly open-label evidence that bupropion can reverse SSRI-induced sexual side effects, but bupropion causes less sexual dysfunction than SSRIs 4.
Effectiveness of Bupropion as an Antidepressant
- A systematic review and meta-analysis published in Therapeutic advances in psychopharmacology found that bupropion is generally well tolerated, has very low rates of sexual dysfunction, and is more likely to cause weight loss than gain 5.
- A prospective trial published in the Journal of clinical psychopharmacology found that bupropion SR augmentation of partial and non-responders to serotonergic antidepressants was effective, with 54% of patients showing a decrease in their HDRS or BDI scores of 50% or more between baseline and Week 6 6.