Bupropion for SSRI-Induced Sexual Dysfunction
Bupropion is highly effective in treating SSRI-induced sexual dysfunction due to its significantly lower rate of sexual adverse events compared to SSRIs, making it an excellent option for managing this common side effect. 1, 2
Mechanism of Action
- Bupropion differs from SSRIs by primarily inhibiting the reuptake of dopamine and norepinephrine rather than serotonin, which is likely responsible for its favorable sexual side effect profile 2
- This unique mechanism allows bupropion to preserve or restore sexual function while maintaining antidepressant efficacy 2
Efficacy in Treating SSRI-Induced Sexual Dysfunction
- Bupropion has been demonstrated to successfully reverse a variety of sexual dysfunctions caused by SSRIs in up to 66% of patients 3
- In a double-blind, placebo-controlled study of women with SSRI-induced sexual dysfunction, bupropion significantly improved sexual function across all domains, with the highest improvements observed in sexual desire (86.4% increase) and lubrication (69.2% increase) 4
- Sexual function improvements typically begin within the first two weeks of bupropion treatment, even at lower doses (100-200 mg/day) 5
Administration Approaches
- Bupropion can be administered in two different ways to address SSRI-induced sexual dysfunction:
- As an adjunct to ongoing SSRI therapy - Adding bupropion SR (typically 150mg daily, up to 150mg twice daily) to counteract the sexual side effects while maintaining the SSRI's antidepressant benefits 5, 4
- As a replacement therapy - Substituting the SSRI with bupropion SR (typically 150mg twice daily) to eliminate sexual dysfunction while maintaining antidepressant efficacy 6
Comparative Sexual Side Effect Profiles
- Paroxetine has higher rates of sexual dysfunction than fluoxetine, fluvoxamine, nefazodone, or sertraline 1, 2
- Bupropion has a significantly lower rate of sexual adverse events than fluoxetine or sertraline 1, 2
- Sexual dysfunction rates are likely underreported in clinical trials and may be more prevalent than documented 1, 7
Important Caveats and Considerations
- While bupropion has fewer sexual side effects, it may be associated with an increased risk for seizures compared to SSRIs, which should be considered in patients with seizure disorders 1, 2
- When switching from an SSRI to bupropion, patients should be monitored for discontinuation symptoms and potential changes in depressive symptoms 2, 6
- For patients with comorbid anxiety disorders, bupropion may be less effective than SSRIs, as it has less established efficacy for anxiety 2
- Side effects such as anxiety and tremor may occur with bupropion and led to discontinuation in approximately 15% of patients in one study 3
Dosing Recommendations
- For adjunctive therapy: Start with bupropion SR 150mg daily and increase to 150mg twice daily if needed 5, 4
- For PRN use: 75mg or 150mg taken 1-2 hours before sexual activity 3
- For replacement therapy: Begin with combined treatment (SSRI plus bupropion), then gradually taper the SSRI while continuing bupropion 6
Bupropion represents an evidence-based approach to managing SSRI-induced sexual dysfunction, either as an adjunctive treatment or as an alternative antidepressant with a more favorable sexual side effect profile.