Wellbutrin Does NOT Cause Erectile Dysfunction
Bupropion (Wellbutrin) is uniquely distinguished among antidepressants by having significantly lower rates of sexual dysfunction compared to SSRIs, and does not cause erectile dysfunction. In fact, the evidence demonstrates it may actually improve sexual function in some patients.
Evidence Supporting Bupropion's Favorable Sexual Profile
Comparative Studies with Other Antidepressants
- Bupropion has significantly lower rates of sexual adverse events than fluoxetine or sertraline according to the American College of Physicians guidelines 1
- Multiple studies confirm bupropion does not worsen sexual function in healthy men, with no differences in self-reported sexual function, nocturnal erections, total erection time, or penile rigidity compared to placebo 2
- In diabetic men with pre-existing erectile dysfunction, bupropion showed a trend toward improved sexual functioning rather than worsening 3
Clinical Trial Data
- In a study of 40 male patients, 24 of 28 patients (86%) who had sexual dysfunction from other antidepressants experienced resolution of their sexual problems when switched to bupropion (p < 0.001) 4
- The 12 patients with no prior sexual dysfunction maintained normal sexual function throughout bupropion treatment 4
- Bupropion's lack of anticholinergic and antiadrenergic effects explains its very low propensity for inducing adverse sexual side effects 4
Contrast with SSRIs
While SSRIs commonly cause sexual dysfunction:
- Paroxetine has the highest rates of sexual dysfunction among antidepressants, exceeding fluoxetine, fluvoxamine, nefazodone, and sertraline 1
- SSRIs typically cause decreased libido, orgasmic dysfunction, and erectile problems 1
- Sexual dysfunction rates with SSRIs are likely underreported in clinical trials 1
FDA-Approved Labeling
The FDA label for bupropion lists "decreased libido" as occurring in 3% of patients versus 2% with placebo, and notes "increased libido" as a postmarketing observation 5. Notably, the label includes "impotence" only in the urogenital postmarketing section without frequency data, suggesting this is an extremely rare occurrence 5.
Clinical Application
For patients experiencing sexual dysfunction from SSRIs, switching to bupropion or adding bupropion as augmentation are evidence-based strategies:
- Bupropion 150 mg twice daily shows significant benefit over placebo for treating SSRI-induced sexual dysfunction (SMD 1.60,95% CI 1.40 to 1.81) 6
- For women with antidepressant-induced sexual dysfunction, higher-dose bupropion appears to be the most promising approach 6
- Systematic reviews confirm bupropion not only avoids sexual side effects but may enhance sexual function in certain individuals 7
Important Caveat
While bupropion carries a slightly increased seizure risk, this must be weighed against its superior sexual side effect profile 1, 8, 9. The seizure risk is dose-dependent and remains low at therapeutic doses.