Can hypersexuality be caused by bupropion (Wellbutrin) or lisdexamfetamine (Vyvanse)?

Hypersexuality and Wellbutrin/Vyvanse

Bupropion (Wellbutrin) does not cause hypersexuality and actually has the lowest rate of sexual dysfunction among antidepressants at 8-10%, while lisdexamfetamine (Vyvanse) can potentially cause hypersexuality as a stimulant-related adverse effect, though this is not well-documented in the literature provided. 1, 2, 3

Bupropion (Wellbutrin) Sexual Effects Profile

Bupropion is specifically recommended as first-line therapy when sexual function is a major concern because it has significantly lower rates of sexual adverse events compared to SSRIs. 1, 2, 3

• Bupropion causes sexual dysfunction in only 8-10% of patients, which is dramatically lower than SSRIs like paroxetine (70.7%), sertraline (14% in males, 6% in females), or fluoxetine. 1, 2, 4
• The American College of Physicians explicitly recommends switching to bupropion when patients experience sexual dysfunction on other antidepressants. 2
• Bupropion is activating rather than sexually suppressive, and may actually improve energy levels and reduce apathy. 1

Important Contraindications for Bupropion

• Do not use bupropion in agitated patients or those with seizure disorders, as weak evidence suggests an increased seizure risk. 1, 3
• Common side effects include insomnia (give second dose before 3 p.m. to minimize this) and headache. 1, 3

Lisdexamfetamine (Vyvanse) and Hypersexuality

While the provided evidence does not directly address lisdexamfetamine, the neurobiological mechanisms suggest potential for hypersexuality:

• Stimulants like amphetamines are implicated in substance-induced hypersexuality through dopamine and noradrenaline pathways in neural reward circuits. 5
• Dopaminergic agents are well-established causes of hypersexuality, and lisdexamfetamine is a prodrug of dextroamphetamine that significantly increases dopamine activity. 5
• The literature confirms that amphetamine substance use can cause hypersexuality as part of its clinical syndrome. 5

Clinical Decision Algorithm

If a patient on Vyvanse develops hypersexuality:

• Consider dose reduction first, as hypersexuality is often dose-dependent with dopaminergic agents. 6
• Evaluate for concurrent psychiatric conditions (bipolar disorder, mania) that may be unmasked or exacerbated by stimulant treatment. 5, 6
• If hypersexuality persists despite dose adjustment, consider switching to a non-stimulant ADHD medication.

If a patient on Wellbutrin reports sexual concerns:

• This is highly unlikely to be hypersexuality caused by bupropion itself, as bupropion has the lowest sexual side effect profile. 1, 2, 3
• Investigate other causes: underlying psychiatric condition (bipolar disorder, mania), concurrent medications, or substance use. 5
• Sexual dysfunction rates are vastly underreported in trials, but bupropion consistently shows protective effects rather than causative effects. 2, 4

Critical Caveat

Hypersexuality is fundamentally different from sexual dysfunction. The evidence overwhelmingly shows that bupropion prevents sexual dysfunction (decreased libido, anorgasmia) rather than causing hypersexuality (abnormally increased sexual activity with distress and impairment). 1, 2, 3, 5