From the Guidelines
Bupropion is a good augmentation to citalopram for anxiety in patients with erectile dysfunction (ED). Typically, bupropion can be started at 150 mg once daily for 1 week, then increased to 150 mg twice daily if needed. This combination works well because while citalopram treats anxiety, it can worsen sexual dysfunction, whereas bupropion often improves sexual function. Bupropion works by increasing dopamine and norepinephrine, which can counteract the sexual side effects of SSRIs like citalopram without reducing their anxiety-relieving effects.
Some key points to consider when using bupropion for this purpose include:
- Monitoring patients for potential side effects such as insomnia, agitation, or increased blood pressure 1.
- Alternative augmentation options include buspirone (starting at 5-7.5 mg twice daily, increasing to 15-30 mg daily) or mirtazapine (7.5-15 mg at bedtime), though these may be less effective specifically for ED 1.
- Lifestyle modifications like regular exercise and stress reduction techniques can also complement medication therapy for both anxiety and sexual function 1.
- The use of SSRIs such as paroxetine, sertraline, citalopram, or fluoxetine may also be beneficial for treating ejaculation problems in men with ED 1.
It's essential to weigh the benefits and risks of each treatment option and consider the individual patient's needs and medical history when making a decision.
From the Research
Augmentation Strategies for Citalopram-Induced Anxiety and ED
- The addition of phosphodiesterase inhibitors such as sildenafil or tadalafil may be an effective strategy for managing erectile dysfunction in men taking citalopram, as evidenced by studies showing improved erectile function compared to placebo 2.
- Bupropion, particularly at higher doses, may be beneficial for women experiencing antidepressant-induced sexual dysfunction, although the evidence is limited 2, 3.
- Buspirone has been shown to improve sexual dysfunction in patients taking selective serotonin reuptake inhibitors (SSRIs), including citalopram, with response rates of approximately 58% compared to 30% with placebo 4, 5.
- Switching to an alternative antidepressant with lower rates of sexual side effects may also be a viable option, although there is limited evidence to support this approach 2, 6.
Considerations for Patients with ED
- Sexual function should be actively assessed at baseline, at regular intervals during treatment, and after treatment cessation to monitor for potential sexual side effects 6.
- Management of antidepressant-induced sexual dysfunction requires an individualized approach, considering factors such as dose reduction, addition of medication to treat the adverse effect, and switching to a different antidepressant 6.
- Post-SSRI sexual dysfunction is a potential, although rare, adverse effect of SSRIs and SNRIs, and should be considered in patients who develop sexual dysfunction during or after antidepressant treatment 6.