Switching from Prozac and Strattera to Wellbutrin for Sexual Side Effects
Direct Answer
Yes, you need to taper fluoxetine (Prozac) gradually over 10-14 days to limit withdrawal symptoms, but atomoxetine (Strattera) tapering requirements are not specifically addressed in the available evidence. 1
Tapering Fluoxetine (Prozac)
The American Academy of Family Physicians explicitly recommends tapering fluoxetine gradually over 10-14 days to limit withdrawal symptoms when discontinuing. 1 This is critical because:
- Fluoxetine has a long half-life but still requires gradual discontinuation to minimize discontinuation syndrome 1
- Abrupt discontinuation can cause withdrawal symptoms including mood changes, dizziness, and flu-like symptoms 1
- The 10-14 day taper period allows for physiologic adjustment as you transition to bupropion 1
Atomoxetine (Strattera) Considerations
The available evidence does not provide specific guidance on tapering atomoxetine when switching to bupropion. However, in clinical practice:
- Atomoxetine is not typically associated with the same discontinuation syndrome as SSRIs
- A gradual taper over 1-2 weeks is generally prudent to monitor for any return of ADHD symptoms
- You can initiate bupropion during the atomoxetine taper
Initiating Bupropion
Bupropion is the optimal choice for your situation, as it has significantly lower sexual dysfunction rates (8-10%) compared to fluoxetine and should be considered first-line when sexual function is a major concern. 2, 1
Starting Bupropion:
- Begin bupropion at 150 mg daily, which can be titrated to 150-400 mg/day as needed 2
- You can start bupropion while tapering fluoxetine—there is no required washout period 2
- Most improvement in sexual function occurs within the first 2 weeks at doses of 100-200 mg/day 3
Critical Safety Warning:
Bupropion carries an increased seizure risk, particularly at doses above 300 mg/day or in patients with predisposing factors including eating disorders, history of seizures, or abrupt alcohol/benzodiazepine discontinuation. 2, 1 Bupropion is contraindicated in patients with seizure disorders or bulimia/anorexia nervosa 2
Monitoring During the Transition
- Assess for discontinuation symptoms from fluoxetine within the first 1-2 weeks 2, 1
- Monitor for therapeutic response to bupropion and any adverse effects within 1-2 weeks of initiation 2
- If inadequate response occurs within 6-8 weeks, consider dose adjustment 2
- Watch for any changes in depressive symptoms during the medication switch 2
Expected Sexual Function Improvement
Bupropion successfully reverses SSRI-induced sexual dysfunction in approximately 66% of patients, with improvement in 69% of specific sexual complaints. 4 The response rates are:
- 75% improvement in men 3
- 46% improvement in women 3
- All categories of sexual side effects (desire, arousal, orgasm) improve with bupropion 3
Important Caveat for ADHD Management
While not explicitly addressed in the evidence, switching from Strattera (atomoxetine) to Wellbutrin (bupropion) may provide some benefit for ADHD symptoms, as bupropion has mild dopamine reuptake blockade 5. However, bupropion is not FDA-approved for ADHD and may be less effective than atomoxetine for this indication. You should discuss with your prescriber whether additional ADHD management will be needed.