Incidence of Erectile Dysfunction with Bupropion and Mirtazapine Combination
The combination of bupropion and mirtazapine has a significantly lower incidence of erectile dysfunction compared to most antidepressant regimens, with bupropion having among the lowest rates (15% in men) and mirtazapine showing relatively low rates (24.4%) of sexual dysfunction. 1, 2
Sexual Side Effect Profiles of Individual Medications
Bupropion
- Consistently shows the lowest rates of sexual dysfunction among antidepressants
- Only 15% of men and 7% of women experience sexual dysfunction 3
- The American College of Physicians identifies bupropion as having the lowest risk of sexual side effects among antidepressants 4
- Often used as a first-line agent when sexual dysfunction is a concern
Mirtazapine
- Has a relatively favorable sexual side effect profile compared to SSRIs
- Approximately 24.4% incidence of sexual dysfunction 2
- Has been shown to improve sexual function when substituted for SSRIs in patients experiencing sexual dysfunction 5
- One study showed significant reduction in sexual problems during mirtazapine treatment, from 93.2% at screening to 24.6% at the end of treatment 6
Comparative Sexual Side Effect Risk
The hierarchy of sexual side effects among common antidepressants is:
| Antidepressant | Risk Level |
|---|---|
| Paroxetine | Highest risk (70.7%) |
| Citalopram | Very high risk (72.7%) |
| Venlafaxine | High risk (67.3%) |
| Sertraline, Fluoxetine | Moderate risk (62.9%, 57.7%) |
| Mirtazapine | Lower risk (24.4%) |
| Bupropion | Lowest risk (15% in men) |
Combination Therapy Considerations
When using bupropion and mirtazapine in combination:
- The complementary mechanisms of action may help offset potential sexual side effects
- Bupropion may actually counteract some of the sexual side effects that might occur with mirtazapine alone
- The combination leverages bupropion's dopaminergic and noradrenergic effects, which can positively impact sexual function
Clinical Implications
- For patients concerned about sexual side effects, the bupropion-mirtazapine combination represents one of the better antidepressant options
- Regular assessment of sexual function should be conducted throughout treatment
- Dosage adjustments may further minimize the risk of sexual dysfunction
- This combination may be particularly beneficial for patients who have experienced sexual dysfunction with other antidepressants, especially SSRIs
Potential Pitfalls and Caveats
- Individual responses may vary; some patients may still experience sexual dysfunction even with this combination
- Other side effects (such as weight gain with mirtazapine or insomnia with bupropion) should be monitored
- Sexual dysfunction may be underreported by patients unless specifically asked about these symptoms
- Physicians consistently underestimate the prevalence of antidepressant-associated sexual dysfunction 1
While the combination of bupropion and mirtazapine offers a favorable sexual side effect profile compared to most other antidepressant regimens, clinicians should still monitor for sexual dysfunction and be prepared to adjust treatment if necessary.