From the Guidelines
Bupropion (Wellbutrin) is an antidepressant that generally does not cause sexual side effects and may even improve sexual function in some people, making it a suitable option for those concerned about decreased libido. According to the American College of Physicians guideline 1, bupropion has a significantly lower rate of sexual adverse events compared to fluoxetine or sertraline. Other medications like mirtazapine (Remeron) and vilazodone (Viibryd) are also less likely to cause sexual dysfunction compared to SSRIs.
Some key points to consider:
- Bupropion affects dopamine and norepinephrine rather than serotonin, which explains why it typically doesn't impact sexual function.
- The typical starting dose for bupropion is 150 mg daily, often increased to 300 mg daily after several days.
- If you're experiencing sexual side effects from your current antidepressant, talk to your doctor about switching medications or adding bupropion to your regimen.
- Never change your medication without consulting your healthcare provider, as antidepressants require careful adjustment and monitoring.
- Other second-generation antidepressants have similar adverse events, with some differences in the incidence of specific adverse events, such as nausea, vomiting, diarrhea, and somnolence 1.
It's essential to discuss adverse event profiles with your physician before selecting a medication, as they can help determine the best course of treatment for your specific needs.
From the FDA Drug Label
Nervous System Abnormal coordination, depersonalization, emotional lability, hyperkinesia, hypertonia, hypesthesia, vertigo, amnesia, ataxia, derealization, abnormal electroencephalogram (EEG), aggression, akinesia, aphasia, coma, dysarthria, dyskinesia, dystonia, euphoria, extrapyramidal syndrome, hypokinesia, increased libido, neuralgia, neuropathy, paranoid ideation, restlessness, suicide attempt, and unmasking tardive dyskinesia.
Bupropion does not cause decreased sex libido, and it may even increase libido in some cases, as stated in the drug label 2.
From the Research
Antidepressants with Lower Risk of Decreased Sex Libido
- Bupropion is associated with a lower risk of sexual dysfunction compared to SSRIs and venlafaxine XR, with a prevalence of sexual dysfunction ranging from 22% to 25% 3
- Nefazodone is also associated with a lower risk of sexual dysfunction, with a prevalence of 28% 3
- Mirtazapine has a lower incidence of sexual dysfunction, with a rate of 24.4% compared to SSRIs and venlafaxine 4
Bupropion as a Treatment for SSRI-Induced Sexual Dysfunction
- Bupropion has been shown to be effective in reversing SSRI-induced sexual dysfunction, with a success rate of 66% in one study 5
- Bupropion SR has been found to be effective in treating SSRI-induced sexual side effects, with a global response rate of 46% for women and 75% for men 6
- Bupropion may be an alternative treatment for depression that does not include the sexual side effects associated with most prescribed antidepressants, although additional research is required 7
Comparison of Antidepressants and Their Risk of Sexual Dysfunction
- SSRIs, such as fluoxetine, sertraline, and paroxetine, have a high incidence of sexual dysfunction, ranging from 57.7% to 70.7% 4
- Venlafaxine has a high incidence of sexual dysfunction, with a rate of 67.3% 4
- Antidepressants with different mechanisms of action, such as nefazodone, mirtazapine, and bupropion, seem to have fewer sexual side effects 4