What antidepressants have lesser sexual dysfunction side effects?

Antidepressants with Lesser Sexual Dysfunction Side Effects

Bupropion is the antidepressant with the lowest risk of sexual dysfunction and should be considered as a first-line option for patients concerned about sexual side effects. 1

Comparative Sexual Side Effect Profiles of Antidepressants

Lower Risk of Sexual Dysfunction

• Bupropion has consistently demonstrated significantly lower rates of sexual adverse events compared to SSRIs like fluoxetine and sertraline 1, 2
• Bupropion not only causes less sexual dysfunction but may actually enhance sexual function in some individuals 3
• Other antidepressants with lower rates of sexual dysfunction include:
  • Mirtazapine 4
  • Nefazodone 4

Higher Risk of Sexual Dysfunction

• SSRIs (Selective Serotonin Reuptake Inhibitors) have the highest incidence of sexual dysfunction 4, 5
• Paroxetine specifically shows higher rates of sexual dysfunction than fluoxetine, fluvoxamine, nefazodone, or sertraline 1
• Sexual side effects from SSRIs can include decreased libido, arousal difficulties, and orgasm dysfunction 2, 5

Clinical Decision Making

When to Consider Sexual Side Effects in Antidepressant Selection

• Sexual dysfunction is a common side effect that can lead to treatment non-compliance 6
• Up to 70% of patients with depression may experience sexual dysfunction 5
• The American College of Physicians recommends selecting antidepressants based on adverse effect profiles, cost, and patient preferences 1

Monitoring and Management

• Begin assessing sexual function early in treatment to identify problems that may lead to non-compliance 5
• For patients already experiencing SSRI-induced sexual dysfunction, consider:
  • Switching to bupropion, which is equally effective for depression but with fewer sexual side effects 2, 3
  • Adding bupropion as an adjunctive therapy to counteract sexual dysfunction from other antidepressants 4, 3

Important Considerations and Caveats

• While bupropion has fewer sexual side effects, it may have other considerations:
  • Weak evidence suggests it may be associated with an increased risk for seizures 1
  • May not be appropriate for all patients depending on their specific depression presentation
• Efficacy for treating depression is generally similar across second-generation antidepressants 1, 7
• When selecting an antidepressant, consider that:
  • Sexual dysfunction is often underreported in clinical trials 1
  • Other common side effects across antidepressants include constipation, diarrhea, dizziness, headache, insomnia, nausea, and somnolence 1, 7