Does Buspar (buspirone) help with sexual dysfunction associated with Selective Serotonin Reuptake Inhibitors (SSRIs)?

Buspirone for SSRI-Induced Sexual Dysfunction

Buspirone may be considered as an option for treating SSRI-induced sexual dysfunction, though evidence supporting its efficacy is limited compared to other alternatives like bupropion.

Mechanism and Evidence

• SSRIs commonly cause sexual dysfunction, with high incidence rates between 57.7% and 62.9%, which can significantly impact medication adherence and quality of life 1
• Buspirone is mentioned in clinical guidelines as a potential off-label treatment option for sexual dysfunction, particularly for low or lack of desire, libido, or intimacy in patients with sexual dysfunction 2
• The National Comprehensive Cancer Network (NCCN) guidelines acknowledge that buspirone has been studied in a few trials involving non-cancer populations for sexual dysfunction, though they note limited safety and efficacy data 2
• Case reports suggest that buspirone may help resolve delayed ejaculation associated with SSRI use, but robust clinical trial evidence is lacking 3

Comparative Effectiveness

• Bupropion has more evidence supporting its use for SSRI-induced sexual dysfunction compared to buspirone 4
• Bupropion is significantly less likely to cause sexual dysfunction in men compared to SSRIs and has been studied more extensively as an antidote 4, 5
• A double-blind, placebo-controlled study found that bupropion significantly improved key aspects of sexual function in women with SSRI-induced sexual dysfunction, with improvements in desire (86.4%) and lubrication (69.2%) 5
• However, some studies show mixed results - a placebo-controlled trial found that a fixed dose of 150 mg/day of bupropion was not effective in treating SSRI-induced sexual dysfunction 6

Clinical Application

• When considering treatment for SSRI-induced sexual dysfunction:
  • Assess the specific type of sexual dysfunction (desire, arousal, orgasm) as different interventions may be more effective for different symptoms 4
  • Consider the patient's primary psychiatric condition, as switching from an SSRI to bupropion may be appropriate for depression but not for anxiety disorders where SSRIs have better established efficacy 4
• If using buspirone for SSRI-induced sexual dysfunction:
  • Start at a low dose and titrate gradually while monitoring for improvement in sexual function 2
  • Be aware that evidence supporting this approach is limited compared to other strategies 3

Important Considerations and Caveats

• Sexual dysfunction is likely underreported in clinical trials and may be more prevalent than documented 4
• Neuroimaging studies suggest that SSRIs like paroxetine reduce activation in brain regions associated with sexual motivation and arousal (ventral striatum, anterior cingulate cortex), which may explain the mechanism of sexual dysfunction 7
• When treating SSRI-induced sexual dysfunction, consider the risk-benefit ratio of adding another medication versus switching to an antidepressant with a lower risk of sexual side effects 4
• Monitoring for drug interactions is essential when combining medications like buspirone with SSRIs 2