What is the role of Wellbutrin (bupropion) in managing sexual overactivity in men with dementia?

Wellbutrin (Bupropion) for Managing Sexual Overactivity in Men with Dementia

Bupropion is not recommended as a first-line treatment for hypersexual behaviors in men with dementia; SSRIs and medroxyprogesterone are the preferred pharmacological options for this condition. 1

First-Line Pharmacological Options

• SSRIs should be considered the primary pharmacological treatment for hypersexual behaviors in men with dementia, with citalopram (10-40 mg daily) being well-tolerated in this population 1
• Medroxyprogesterone is recommended as an alternative first-line option specifically for sexual disinhibition in men with dementia 1
• Carbamazepine can be considered when first-line treatments are ineffective 1

Bupropion's Role and Limitations

• Bupropion is associated with a significantly lower rate of sexual adverse events compared to SSRIs like fluoxetine and sertraline, making it counterproductive for treating hypersexuality 2
• Bupropion may actually worsen inappropriate sexual behaviors in dementia patients due to its stimulating properties and lack of serotonergic activity that helps reduce sexual impulses 3, 4
• The pharmacological profile of bupropion (dopamine and norepinephrine reuptake inhibition) does not target the neurochemical pathways typically associated with reducing hypersexual behaviors 4

Evidence-Based Approach to Hypersexual Behaviors in Dementia

• Inappropriate sexual behaviors are common in people with dementia but are often underrecognized and undertreated 5, 6
• No randomized controlled trials exist specifically for pharmacological treatment of inappropriate sexual behaviors in dementia, with evidence primarily from case reports and case series 4, 7
• The management approach should follow this algorithm:
  1. Start with an SSRI (particularly citalopram) as first-line treatment 1, 6
  2. If ineffective, consider medroxyprogesterone (for men specifically) 1, 3
  3. Consider carbamazepine as a third-line option 1

Medications to Avoid

• Thioridazine, chlorpromazine, and trazodone should not be used for hypersexuality in dementia patients 1
• Conventional antipsychotics like haloperidol should not be first-line management 1
• Bupropion should be avoided due to its potential to worsen rather than improve hypersexual behaviors 2, 3

Clinical Considerations and Monitoring

• Investigate and address potential underlying causes of behavioral changes before initiating pharmacological treatment 1
• Evaluate response to pharmacological interventions within 30 days; if minimal improvement occurs, consider alternative treatments 1
• Consider tapering or discontinuing pharmacological treatments after 6 months of symptom stabilization 1
• Monitor for adverse effects, particularly with SSRIs, which may include nausea and sleep disturbances 1

Common Pitfalls to Avoid

• Relying solely on medications without implementing non-pharmacological strategies 1
• Using medications with significant anticholinergic effects that can worsen cognitive symptoms 1
• Failing to monitor for medication side effects that may worsen behavioral symptoms 1
• Not considering the risk-benefit ratio, especially given limited FDA approval for psychotropics in treating neuropsychiatric symptoms in dementia 1
• Selecting bupropion based on its antidepressant properties without recognizing its potential to exacerbate hypersexual behaviors due to its unique mechanism of action 2, 3