Can adding Bupropion (Wellbutrin) to Citalopram (Celexa) help minimize sexual side effects?

From the Guidelines

Adding bupropion (Wellbutrin) to citalopram (Celexa) is a recommended strategy to help minimize sexual side effects associated with citalopram alone, as evidenced by a weighted mean incidence of sexual effects of 40% with SSRIs, which can be decreased with bupropion 1.

Key Considerations

• Bupropion is commonly used as an antidepressant augmentation strategy to counteract sexual dysfunction caused by selective serotonin reuptake inhibitors (SSRIs) like citalopram.
• The combination of bupropion and citalopram works due to their different mechanisms of action, with citalopram primarily affecting serotonin and bupropion affecting dopamine and norepinephrine.
• Bupropion's dopaminergic effects are thought to counterbalance the serotonergic effects that cause sexual dysfunction, as noted in the study published in the American Family Physician in 2015 1.

Implementation and Monitoring

• Typically, bupropion is added at doses of 150-300 mg daily, often starting at 150 mg once daily and potentially increasing to 150 mg twice daily if needed and tolerated.
• Patients should be aware that this combination may increase the risk of side effects such as anxiety, insomnia, or elevated blood pressure, and should be monitored by their healthcare provider.
• It's essential to start bupropion at a lower dose and gradually increase it while watching for any adverse effects, as individual responses vary and medication interactions need to be carefully managed 1.

Important Notes

• This approach should only be implemented under medical supervision to ensure safe and effective management of potential side effects and interactions.
• The study published in the American Family Physician in 2015 provides evidence for the use of bupropion to minimize sexual side effects associated with SSRIs like citalopram, highlighting the importance of considering this strategy in clinical practice 1.

From the Research

Adding Wellbutrin to Celexa for Minimizing Sexual Side Effects

• The combination of Bupropion (Wellbutrin) and Citalopram (Celexa) has been studied to determine its effectiveness in minimizing sexual side effects associated with Selective Serotonin Reuptake Inhibitors (SSRIs) like Celexa 2, 3.
• Research suggests that Bupropion can be effective in treating SSRI-induced sexual side effects, with global response rates of 46% for women and 75% for men in one study 2.
• A review of the literature on combining Bupropion with SSRIs or Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) found that controlled and open-label studies support the effectiveness of Bupropion in reversing antidepressant-associated sexual dysfunction 3.
• Another study compared the effects of Bupropion extended release and escitalopram on sexual functioning and antidepressant efficacy, finding that Bupropion had a significantly better sexual tolerability profile than escitalopram 4.
• A systematic review and meta-analysis of Bupropion's effectiveness as an antidepressant found that it is generally well tolerated, with low rates of sexual dysfunction, and may be particularly useful for patients who experience weight gain or sexual dysfunction with other antidepressants 5.
• Overall, the evidence suggests that adding Bupropion to Celexa may be a viable strategy for minimizing sexual side effects, although more research is needed to fully understand its effects 6.

Key Findings

• Bupropion can be effective in treating SSRI-induced sexual side effects 2, 3.
• Bupropion has a better sexual tolerability profile than some SSRIs, such as escitalopram 4.
• Bupropion is generally well tolerated, with low rates of sexual dysfunction 5.
• The combination of Bupropion and an SSRI or SNRI may be effective for treating major depressive disorder, although more research is needed 3.

Studies

• A 2002 study found that Bupropion was effective in treating SSRI-induced sexual side effects in 46% of women and 75% of men 2.
• A 2006 review of the literature found that Bupropion can be effective in reversing antidepressant-associated sexual dysfunction 3.
• A 2016 systematic review and meta-analysis found that Bupropion is generally well tolerated, with low rates of sexual dysfunction, and may be particularly useful for patients who experience weight gain or sexual dysfunction with other antidepressants 5.
• A 2006 study compared the effects of Bupropion extended release and escitalopram on sexual functioning and antidepressant efficacy, finding that Bupropion had a significantly better sexual tolerability profile than escitalopram 4.
• A 2008 review found that Bupropion causes less sexual dysfunction than SSRIs and may be able to reverse SSRI-induced sexual side effects 6.