Antidepressant That Increases Libido
Bupropion is the antidepressant of choice when sexual function is a concern, as it is the only antidepressant that consistently improves libido rather than impairing it. 1, 2
Why Bupropion is Unique
Bupropion stands apart from other antidepressants due to its dopamine-norepinephrine reuptake inhibition mechanism, which contrasts sharply with SSRIs and SNRIs that commonly cause sexual dysfunction. 3
Key evidence supporting bupropion's pro-sexual effects:
- 77% of bupropion-treated patients reported at least one aspect of heightened sexual functioning beyond their pre-illness baseline 4
- 86% of bupropion patients experienced no adverse sexual effects, compared to only 27% of SSRI-treated patients 4
- Patients specifically reported significant increases in libido, arousal intensity, orgasm intensity, and orgasm duration 4
- The FDA drug label explicitly lists "increased libido" as a documented nervous system effect of bupropion 2
Clinical Evidence Across Populations
In breast cancer survivors (a population with particularly high rates of sexual dysfunction from both disease and treatment):
- Bupropion 150 mg daily significantly improved sexual function scores after 4 weeks of treatment 5
- The improvement persisted through 8 weeks of treatment 5
- This is particularly relevant since guidelines note that SSRIs/SNRIs should be stopped in breast cancer patients with sexual dysfunction, as these medications reduce libido and cause anorgasmia 6
In patients switching from SSRIs:
- 94% of patients who developed orgasm dysfunction on fluoxetine had complete or partial resolution after switching to bupropion 7
- 81% reported "much" or "very much" increased libido after the switch 7
- Depression control was maintained or improved during the transition 7
Comparison with Other Antidepressants
SSRIs (fluoxetine, paroxetine, sertraline, citalopram) cause significant sexual dysfunction:
- Fluoxetine has sexual dysfunction rates of 57.7-62.9% 8
- These medications significantly decrease libido, arousal, orgasm duration, and orgasm intensity below pre-illness levels 4
- Paroxetine has particularly high rates of sexual dysfunction compared to other SSRIs 1
SNRIs (venlafaxine, desvenlafaxine, duloxetine) also impair sexual function and should be avoided when libido is a concern 6
Practical Prescribing
Dosing:
- Start bupropion at 150 mg daily 5
- Can increase to 300-450 mg daily as needed for depression control 3
- Sexual function improvements may be evident within 4 weeks 5
Important safety considerations:
- Bupropion carries a slightly increased seizure risk compared to SSRIs, particularly at doses above 450 mg daily 1, 2
- Avoid in patients with seizure disorders, eating disorders, or abrupt alcohol/benzodiazepine discontinuation 2
- Use caution when combining with other medications that lower seizure threshold 2
When bupropion may not be ideal:
- Patients with comorbid anxiety disorders may respond better to SSRIs despite sexual side effects, as bupropion has less established efficacy for anxiety 1
- In such cases, consider adding buspirone (off-label) to an SSRI to mitigate sexual dysfunction rather than switching 1
Historical Context
Older studies from the 1980s-1990s established that bupropion has "very low propensity for inducing adverse sexual side effects" and that patients with pre-existing SSRI-induced sexual dysfunction experienced resolution when transferred to bupropion 9, 7. This evidence has remained consistent and is now reflected in current guidelines 1 and FDA labeling 2.