Can Wellbutrin (bupropion) be used as an adjunct to improve libido?

Bupropion as an Adjunct to Improve Libido

Bupropion is an effective adjunctive treatment for improving libido and can be recommended for patients experiencing sexual dysfunction, particularly those with decreased libido related to other antidepressant medications. 1, 2

Mechanism and Evidence

• Bupropion works as a dopamine/norepinephrine reuptake inhibitor, which differs from SSRIs and other antidepressants that commonly cause sexual dysfunction 3
• Unlike most antidepressants, bupropion has been shown to have minimal sexual side effects and may actually enhance sexual function in certain individuals 4
• The NCCN Survivorship Guidelines specifically mention bupropion as an off-label option for survivors with hypoactive sexual desire disorder (HSDD) 1
• Bupropion has demonstrated effectiveness in treating sexual dysfunction caused by other antidepressants, particularly SSRIs 2, 5

Clinical Applications

For Antidepressant-Induced Sexual Dysfunction

• Bupropion can be used as an adjunctive treatment for patients experiencing sexual dysfunction (including decreased libido) while taking SSRIs 2, 5
• In a Cochrane review, bupropion at higher doses (150 mg twice daily) showed benefit over placebo for treating antidepressant-induced sexual dysfunction 2
• Neural imaging studies demonstrate that bupropion does not reduce activation in brain regions associated with sexual arousal, unlike SSRIs such as paroxetine 6

For Primary Treatment of Low Libido

• Bupropion can be considered as a primary antidepressant for patients with depression who are concerned about sexual side effects 7, 4
• In an early study of 40 male patients, 24 of 28 patients with a history of sexual dysfunction on other antidepressants showed resolution of these issues when transferred to bupropion (p<0.001) 7

Dosing Recommendations

• For adjunctive treatment of sexual dysfunction:

  • Bupropion SR: Start with 100-150 mg daily, with maintenance dose of 100-150 mg twice daily 1
  • Bupropion XL: Start with 150 mg daily, with maintenance dose of 150-300 mg daily 1
  • Maximum dose: 450 mg per day 1

• When using as an adjunct specifically for libido:

  • Higher doses (150 mg twice daily) have shown greater benefit than lower doses (150 mg once daily) for sexual dysfunction 2
  • Morning administration is recommended due to its activating properties that can cause insomnia if taken later in the day 8

Potential Side Effects and Precautions

• Common side effects include insomnia (7-12%), dry mouth, headache, and agitation 8, 3
• Bupropion may actually increase libido in some patients, which is listed as a potential nervous system effect in the FDA label 3
• Avoid evening dosing due to potential for sleep disturbances 8
• Use caution when combining with medications metabolized by CYP2D6 (including many antidepressants) as bupropion can increase their levels 3
• Contraindicated with MAOIs - allow at least 14 days between discontinuing MAOIs and starting bupropion 3

Monitoring and Follow-up

• Assess for improvement in libido and sexual function after initiating bupropion 4
• Monitor for potential side effects, particularly insomnia, agitation, or anxiety 3
• Consider long-term therapy as sexual dysfunction typically returns upon discontinuation of treatment 1

Bupropion represents a valuable option for addressing libido concerns, either as a primary antidepressant with favorable sexual side effect profile or as an adjunctive treatment for sexual dysfunction caused by other medications.