Adding Wellbutrin (Bupropion) to SSRIs for Low Libido
Bupropion is highly effective in treating SSRI-induced sexual dysfunction, particularly low libido, with success rates of 66-77% when added to an SSRI regimen. 1, 2
Mechanism of Action
- Bupropion counteracts SSRI-induced sexual dysfunction through its unique pharmacological profile as a norepinephrine and dopamine reuptake inhibitor, which differs from serotonergic mechanisms of SSRIs 3
- While SSRIs significantly decrease libido, arousal, and orgasm intensity, bupropion has been shown to increase these aspects of sexual function beyond pre-illness levels 2
- Neuroimaging studies show that bupropion increases activity in brain regions associated with sexual motivation and arousal, including the posterior midcingulate cortex, mediodorsal thalamus, and extended amygdala 3
Efficacy for SSRI-Induced Sexual Dysfunction
- In clinical studies, bupropion successfully reversed various sexual dysfunctions caused by SSRIs in approximately 66% of patients 1
- About 69% of specific sexual complaints improved with bupropion treatment 1
- Comparative studies found that 77% of bupropion-treated patients reported at least one aspect of heightened sexual functioning, while 73% of SSRI-treated patients experienced decreased sexual function 2
- Global response rates to bupropion for SSRI-induced sexual side effects were 46% for women and 75% for men 4
Dosing and Administration
- Bupropion can be administered either as a scheduled daily medication or as needed before sexual activity 1
- For as-needed use, 75-150 mg taken 1-2 hours before sexual activity can be effective 1
- For scheduled use, doses typically range from 100-300 mg daily 4, 5
- Most improvement (>50%) occurs within the first two weeks and at lower doses (100-200 mg/day) 4
Advantages Over Other Approaches
- Unlike SSRIs, which commonly cause sexual dysfunction, bupropion has a favorable sexual side effect profile 6
- Bupropion has significantly lower rates of sexual adverse events compared to fluoxetine or sertraline 6
- In non-depressed individuals with orgasmic dysfunction, bupropion improved sexual satisfaction, orgasm intensity, and reduced orgasmic delay compared to placebo 5
Potential Side Effects and Precautions
- The most common side effects of bupropion include anxiety and tremor, which led to discontinuation in about 15% of patients in one study 1
- Bupropion has a lower risk of sexual dysfunction than SSRIs but carries a slightly increased risk of seizures 6
- When combining medications, monitor for potential drug interactions, particularly with other medications metabolized by the cytochrome P450 system 6
Clinical Implementation
- Consider adding bupropion when patients report decreased libido, arousal difficulties, or orgasmic problems while on SSRI therapy 4, 1
- Bupropion can be added to any SSRI regimen, with studies showing efficacy when combined with fluoxetine, paroxetine, and sertraline 2
- Improvements typically affect all aspects of sexual function rather than just one specific area 4
- The prosexual effects of bupropion appear to be independent of its antidepressant activity, making it useful even in non-depressed patients 5