Wellbutrin Does NOT Cause Erectile Dysfunction
Bupropion (Wellbutrin) is significantly less likely to cause erectile dysfunction compared to other antidepressants, and in fact may improve sexual function in some patients. 1, 2
Evidence from Clinical Guidelines and FDA Labeling
The American College of Physicians explicitly states that bupropion has significantly lower rates of sexual dysfunction (8-10%) compared to SSRIs like fluoxetine and sertraline (14-70.7% depending on the agent). 1, 2 This makes bupropion the preferred first-line antidepressant when sexual function is a concern. 3, 1
The FDA drug label for bupropion lists "increased libido" as a documented side effect, not decreased libido or erectile dysfunction. 4 While the label mentions "impotence" as a postmarketing adverse event, this occurs in the context of a medication that overall improves rather than impairs sexual function. 4
Research Evidence Supporting Bupropion's Sexual Safety Profile
Multiple controlled trials demonstrate bupropion's favorable sexual profile:
In diabetic men with pre-existing erectile dysfunction, bupropion showed a trend toward improved erectile response rather than worsening, with no adverse effects on sexual function over 6 weeks of treatment. 5
In healthy men without sexual dysfunction, a placebo-controlled crossover trial found no differences in self-reported sexual function, number of erections, total erection time, or penile rigidity when taking bupropion 300 mg/day compared to placebo. 6
In men with antidepressant-induced sexual dysfunction, 24 of 28 patients (86%) experienced resolution of their sexual problems when switched from tricyclics, MAOIs, or other antidepressants to bupropion. 7
In direct comparison with sertraline, only 15% of men and 7% of women on bupropion SR developed sexual dysfunction, compared to 63% of men and 41% of women on sertraline. 8
Clinical Algorithm for Antidepressant Selection
When prescribing antidepressants to men concerned about erectile function:
Start with bupropion 150-300 mg/day as first-line therapy if depression requires treatment and sexual function is a priority. 3, 1
Avoid SSRIs entirely if sexual function is the primary concern, particularly paroxetine (70.7% sexual dysfunction rate). 2
If switching from an SSRI due to sexual dysfunction, taper the SSRI over 10-14 days and transition to bupropion monotherapy. 3
Important Safety Considerations
Bupropion carries an increased seizure risk (particularly at doses >300 mg/day) and is contraindicated in patients with seizure disorders, eating disorders (bulimia/anorexia), or abrupt alcohol/benzodiazepine discontinuation. 1, 2 This seizure risk is the primary limiting factor, not sexual dysfunction.
Do not use bupropion in agitated patients due to its activating properties. 2 Consider mirtazapine as an alternative in such cases, though it causes sedation and weight gain. 2
Common Pitfall to Avoid
The most common error is assuming all antidepressants carry similar sexual dysfunction risks. The difference between bupropion (8-10% sexual dysfunction) and SSRIs like paroxetine (70.7%) is clinically massive and should drive prescribing decisions. 1, 2 Sexual dysfunction from antidepressants is vastly underreported in clinical trials, making real-world rates likely higher than published figures for SSRIs but not changing bupropion's favorable profile. 2