Does bupropion (Wellbutrin) increase sexual libido?

Bupropion and Sexual Libido

Bupropion (Wellbutrin) can increase sexual libido and has significantly lower rates of sexual adverse events compared to SSRIs like fluoxetine and sertraline, making it a preferred option for patients concerned about sexual dysfunction. 1

Sexual Side Effect Profile of Antidepressants

Comparative Sexual Effects of Different Antidepressants

• Bupropion has a significantly lower rate of sexual adverse events compared to SSRIs such as fluoxetine and sertraline 1
• Paroxetine has higher rates of sexual dysfunction than fluoxetine, fluvoxamine, nefazodone, or sertraline 1
• Most SSRIs commonly cause sexual adverse events including decreased libido and orgasmic dysfunction 1
• Sexual dysfunction is likely underreported in clinical trials of antidepressants 1

Bupropion's Positive Effects on Sexual Function

• Bupropion not only avoids sexual dysfunction but may actually enhance sexual function in certain individuals 2
• In studies examining patients with psychosexual dysfunction, 63% of bupropion-treated patients reported themselves much or very much improved, compared with only 3% for placebo 3
• The onset of therapeutic sexual effects with bupropion is gradual, with improvements primarily in libido and global assessments of sexual functioning 3

Mechanism of Action and Neural Correlates

• Bupropion is a norepinephrine and dopamine reuptake inhibitor, which may explain its different sexual side effect profile compared to SSRIs 4
• Neuroimaging studies show that SSRIs like paroxetine decrease activation in brain regions related to motivation (ventral striatum) and emotional/autonomic components of erotic stimulation (anterior cingulate cortex) 4
• Bupropion increases activity in brain regions including posterior midcingulate cortex, mediodorsal thalamus, and extended amygdala relative to placebo and paroxetine, which may relate to its lack of sexual side effects 4

Treatment of SSRI-Induced Sexual Dysfunction

• Bupropion is effective in treating sexual dysfunction caused by SSRIs 5, 6
• When patients with fluoxetine-associated sexual dysfunction were switched to bupropion:
  • 94% had complete or partial resolution of orgasm dysfunction 6
  • 81% were "much" or "very much" more satisfied with their overall sexual functioning 6
  • 81% reported "much" or "very much" increased libido 6
• Response rates to bupropion for SSRI-induced sexual side effects were 46% for women and 75% for men 5
• Most improvement (more than 50%) occurred within the first 2 weeks and at low doses (100-200 mg/day) 5

Clinical Considerations

Dosing and Administration

• Bupropion dosages ranging from 150-300 mg daily have shown efficacy for improving sexual function 5, 6
• Improvement in sexual function may begin within the first two weeks of treatment 5

Potential Risks and Adverse Effects

• While bupropion has advantages regarding sexual function, it has other potential side effects to consider:
  • Weak evidence indicates bupropion may be associated with an increased risk for seizures 1
  • Common side effects include insomnia and headache 1
  • Bupropion has lower rates of somnolence compared to several other antidepressants 1

Special Populations

• Bupropion's effects on sexual function appear to benefit both men and women, though response rates may be higher in men (75%) than women (46%) 5
• Second-generation antidepressants, including bupropion, show similar efficacy across age groups, sexes, and racial/ethnic groups 1

Practical Application

• For patients with depression who are concerned about sexual side effects, bupropion is a preferred first-line option 2
• For patients already experiencing sexual dysfunction on SSRIs, switching to bupropion may resolve these issues while maintaining antidepressant efficacy 6
• Bupropion can also be added to existing SSRI therapy to counteract sexual side effects when switching is not preferred 5, 2