Sexual Side Effects of Bupropion
Bupropion has the lowest rate of sexual dysfunction among antidepressants and is the preferred choice when sexual side effects are a concern. 1, 2
Key Clinical Evidence
Comparative Sexual Dysfunction Rates
- Bupropion demonstrates significantly lower rates of sexual adverse events compared to SSRIs, with rates of 15% in men and 7% in women versus 63% and 41% respectively for sertraline 3
- Head-to-head trials show bupropion has significantly lower sexual side effects than fluoxetine and sertraline 1
- In healthy men without psychiatric illness, bupropion at 300 mg/day showed no differences in self-reported sexual function, nocturnal erections, total erection time, or penile rigidity compared to placebo 4
Mechanism and Clinical Profile
- Bupropion's lack of anticholinergic and antiadrenergic effects explains its minimal sexual side effect profile 5
- In patients with pre-existing sexual dysfunction from other antidepressants (tricyclics, MAOIs, SSRIs), sexual function resolved in 86% (24 of 28 patients) when switched to bupropion 5
- Patients with normal sexual function maintained normal functioning when treated with bupropion 5
Important Clinical Considerations
Therapeutic Use for SSRI-Induced Sexual Dysfunction
- Bupropion SR can be used as an augmentation strategy for SSRI-induced sexual side effects, with global response rates of 75% in men and 46% in women 6
- Most improvement occurs within the first 2 weeks at doses of 100-200 mg/day 6
- All categories of sexual side effects (libido, arousal, orgasm) improve with bupropion augmentation 6
Safety Caveats
- Weak evidence suggests bupropion may be associated with increased seizure risk, which should be considered in patient selection 1
- Common non-sexual side effects include nervousness and insomnia 7
- Bupropion inhibits CYP2D6, raising concerns for drug interactions 7
Practical Application
- Sexual dysfunction rates are likely underreported in clinical trials, so the actual benefit of bupropion may be even greater than reported 1
- Bupropion maintains comparable antidepressant efficacy to SSRIs while offering superior sexual tolerability 3, 7
- The American College of Physicians recommends selecting antidepressants based on adverse effect profiles and patient preferences, making bupropion an excellent first-line choice for sexually active patients 2