Increased Sexual Desire as a Side Effect of Antidepressant and Mood Stabilizer Medications
Increased sexual desire (hypersexuality) can occur as a side effect of some antidepressant medications, particularly bupropion, but is uncommon with most other antidepressants and mood stabilizers, which typically cause sexual dysfunction rather than increased libido.
Understanding Sexual Side Effects of ASMs
Common Sexual Side Effects
- Most antidepressants, particularly SSRIs, are associated with sexual dysfunction rather than increased libido 1, 2
- Sexual dysfunction affects approximately 59.1% of patients taking antidepressants 3
- The hierarchy of sexual side effects among common antidepressants is:
Medications Associated with Increased Libido
Bupropion
- Bupropion is uniquely associated with reports of increased libido as a side effect 4, 5
- The FDA label for bupropion specifically lists "increased libido" among its neurological side effects 4
- Bupropion is often used as an augmentation strategy to counteract SSRI-induced sexual dysfunction due to its pro-sexual effects 6
Other Medications with Lower Sexual Side Effects
- Mirtazapine has lower rates of sexual dysfunction (24.4%) compared to SSRIs 3
- Nefazodone, moclobemide, and amineptine have the lowest rates of sexual dysfunction among antidepressants 7, 3
Clinical Implications and Management
Assessment Considerations
- Sexual side effects are often underreported by patients 2
- Baseline sexual function should be assessed before starting treatment
- Regular monitoring for changes in sexual function throughout treatment is recommended
Management Strategies for Sexual Side Effects
- For patients experiencing decreased libido on SSRIs, switching to bupropion may improve sexual function 6
- When increased sexual desire is problematic:
- Consider dose adjustment
- Switch to an antidepressant with different mechanism of action
- Monitor for other symptoms of mood elevation that might indicate hypomania
Medication Selection Based on Sexual Function Concerns
- For patients concerned about decreased libido: Consider bupropion as first-line 2, 5
- For patients where increased libido would be problematic: SSRIs may be preferable
- Avoid paroxetine when any sexual function is a concern due to highest rates of sexual dysfunction 2
Pitfalls and Caveats
- Increased libido could potentially be a sign of emerging hypomania/mania rather than a direct medication effect
- Sexual dysfunction is significantly more common than hypersexuality with most antidepressants
- Patient reports of improved sexual function may reflect improvement in depression rather than a direct medication effect
- Most studies on sexual effects of antidepressants have methodological limitations 8
- Many studies do not specifically assess for increased libido, focusing instead on dysfunction
In summary, while most antidepressants and mood stabilizers are associated with sexual dysfunction, bupropion stands out as having potential to increase libido in some patients. This effect can be therapeutically useful when addressing SSRI-induced sexual dysfunction but should be monitored if problematic.