From the Guidelines
Combining trazodone with bupropion may be a viable approach to address sexual dysfunction in men, particularly when the sexual issues are related to antidepressant treatment, as bupropion has a lower rate of sexual adverse events compared to other antidepressants 1.
Key Considerations
- Bupropion (Wellbutrin) at doses of 150-300mg daily can counteract sexual side effects caused by other antidepressants, as it has minimal sexual side effects and may even enhance sexual function through its dopaminergic effects.
- Trazodone at low doses (25-100mg) can help with erectile function due to its alpha-adrenergic blocking properties, though higher doses may actually cause sexual dysfunction.
- When using this combination, start with lower doses and adjust based on response and side effects.
- Bupropion should be taken in the morning to avoid insomnia, while trazodone is typically taken at bedtime as it causes sedation.
Mechanism and Rationale
- This combination works because bupropion increases dopamine and norepinephrine (which can enhance libido and arousal), while low-dose trazodone can improve blood flow to the penis.
- However, it's essential to note that trazodone's efficacy in treating erectile dysfunction is not recommended based on a review of the data and panel consensus 1.
Alternative Approaches
- Other treatments may help with ED and ejaculation and orgasm issues, such as pelvic physical therapy, vibratory therapy, and SSRIs (paroxetine, sertraline, citalopram, fluoxetine) dosed daily or clomipramine dosed on-demand 1.
Important Considerations
- Potential side effects include insomnia, anxiety, or headaches from bupropion and sedation, dizziness, or priapism (rare but serious) from trazodone.
- This approach should be medically supervised and may not be appropriate for all men, particularly those with seizure disorders, eating disorders, or certain cardiovascular conditions.
From the Research
Effect of Combining Trazodone with Bupropion on Male Sexual Function
- The combination of Trazodone with Bupropion on male sexual function is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, individual studies on Trazodone and Bupropion provide some insights:
- Trazodone, a 5-HT2A and 5-HT2C receptor antagonist and selective serotonin reuptake inhibitor, has been used to treat sexual dysfunction induced by serotonin reuptake inhibitors 3.
- Bupropion, a norepinephrine and dopamine reuptake inhibitor, has been shown to have no adverse effects on sexual function in nondepressed diabetic men with erectile dysfunction, and may even improve sexual functioning 5.
- A study on the use of Trazodone for the treatment of sexual dysfunction induced by serotonin reuptake inhibitors found that Trazodone improved sexual function in men, including erectile performance 3.
- Another study suggested that low doses of Trazodone (3.5-19.2 mg daily) may be effective in improving sexual desire and arousal without causing CNS depression 6.
- The potential benefits of combining Trazodone with Bupropion on male sexual function are not explicitly stated in the provided studies, but the individual effects of these medications on sexual function are reported 2, 3, 5, 6.