Sexual Dysfunction and Wellbutrin

Bupropion is sold under the brand name Wellbutrin.  This medication is FDA approved for the treatment of depression.  It is also approved to help people stop smoking.

An additional benefit of Wellbutrin is that it does not interfere with sexual function.  All of the other medications used for the treatment of depression strongly interfere with sexual function.

How Does Welbutrin Work?

Welbutrin works primarily in the brain.  It increases the level of two chemicals in the brain – dopamine and noradrenaline[1].  These chemicals are called neurotransmitters.  Neurotransmitters are the chemical signals that allow one nerve to communicate with another nerve.

There is another important class of medicines used to treat depression called the SSRI’s.  SSRI stands for selective serotonin reuptake inhibitor.  These medications increase the level of serotonin in the brain[2].  Serotonin is also a neurotransmitter.  Examples of the SSRI’s include Prozac and Zoloft.

Unlike Wellbutrin, the SSRI’s have a negative impact upon sexual function. There is a simple chemical explanation for this.

Dopamine vs Serotonin

These are two important neurotransmitters in the brain that regulate sexual function.  The first one is dopamine.  Dopamine stimulates sexual function.  Sexual function improves when dopamine levels increase in the brain.

The second important neurotransmitter is serotonin.  Serotonin inhibits sexual function.  Sexual function goes down when serotonin levels increase in the brain.

Wellbutrin increases dopamine levels in the brain and this has a beneficial effect upon sexual function.  The SSRI’s, on the other-hand, increase serotonin levels.  As a result, the SSRI’s interfere with sexual function.

Sexual Function Cycle

The basic phases of sexual function include desire, arousal and orgasm.

In men, these specific steps in sexual function include desire, erection, orgasm including ejaculation, and resolution.

In woman, the steps include, desire, arousal including vaginal lubrication, orgasm and resolution.

Psychiatric Medication and Sexual Dysfunction

Studies of psychiatric medication and sexual dysfunction generally do not address the specific phases of sexual function[3].  The studies investigate and reach conclusions about the effects of psychiatric medications on overall sexual function.  Very little is known about the effects of these medications on the individual phases of sexual function.  Most of the studies are based on questionnaires given to patients who receive psychiatric medication.  More studies are needed with regard to the effect of psychiatric medication upon specific aspects of sexual function.

Is Sexual Dysfunction Due to the Medicine or the Disease?

If a psychiatric patient is suffering from sexual dysfunction, it is very difficult to determine if the sexual dysfunction is caused by the medication or by the underling disease.

Studies have shown that 40% to 60% of patients with depression suffer from sexual dysfunction before they receive treatment[4].  Patients who have anxiety, bipolar disease and schizophrenia also have a high incidence of sexual dysfunction.

In addition, many psychiatric patients have other comorbid diseases that can cause sexual dysfunction.  These include hypertension, diabetes, hypercholesterolemia and coronary artery disease.

So if you are on a psychiatric medication and you are having sexual dysfunction, discuss this issue with your psychiatrist.  Do not abruptly stop taking your medication.  The cause of your sexual dysfunction may not be due to your medication. Instead, it may be due to your underlying disease.  Stopping your medication may be dangerous and stopping your medication may make your sexual performance worse.

Wellbutrin – Side Effects

The most serious side effects of Wellbutrin include seizures and suicide.  Fortunately, both of these side effects are rare.  Nevertheless, patients with depression who are taking Wellbutrin must be closely monitored by their psychiatrist.

Treatment Strategies for Sexual Dysfunction

If you are taking psychiatric medication and are suffering from sexual dysfunction, such as erectile dysfunction, there are several treatment strategies that may be appropriate.  The first priority is always to effectively treat your psychiatric illness.  With this in mind, there are several strategies that your psychiatrist may try to reduce the effect of your medication upon sexual function.

The first strategy is to wait.  Sometimes, the side effects of a new psychiatric medicine decreases with time as your body becomes accustomed to your medication.

The second strategy involves switching your medication to one with fewer side effects.  If you have depression, you can discuss with your psychiatrist whether you are a candidate for Wellbutrin.

A third strategy involves lowering the dose of your medication.  Do not attempt this on your own.

And finally, it is possible to directly treat your sexual dysfunction with medications such as
Viagra or testosterone supplements[5].

Psychiatric Meds That Cause Severe Sexual Dysfunction[6].

  1. Amitriptyline – brand name Elavil – is a tri-cyclic anti-depressant.
  2. Celexa – brand name Citalopram – is an SSRI used to treat depression.
  3. Imipramine – brand name Tofrinil is a tri – cyclic anti-depressant.
  4. Sertraline – brand name Zoloft – is an SSRI used to treat depression.
  5. Fluoxetine – brand name Prozac – is an SSRI used to treat depression.
  6. Paroxetine – brand name Paxel – is an SSRI used to treat depression.
  7. Risperidone brand Risperdol – is used to treat schizophrenia.
  8. Haloperidol – brand name Haldol – is used to treat schizophrenia.

Psychiatric Meds That Cause Mild Sexual Dysfunction

  1. Bupropion – brand name Wellbutrin – is used to treat depression.
  2. Mirtazapine – brand name Remeron – is used to treat depression.
  3. Lithium – is used to treat manic-depression or bipolar disease.
  4. Diazepam – brand name Valium – is used to treat anxiety.
  5. Lorazepam – brand name Ativan – is used to treat anxiety.
  6. Methylphenidate – brand name Concerta- is used to treat ADHD.
  7. Aripiprazole- brand name Abilify – is used to treat Schizophrenia.
  8. Olanzapine – brand name Zyprexa – is used to treat schizophrenia.

[1] Fava, M, Rush, J, Thase, M, Clayton, A, Stahl, S, Pradko, J, Johnston, J, 15 Years of Experience With Bupriopion, Journal of Clinical Psychiatry, 7, 106 – 113, 2005

[2] Nieuwstraten, C, Dolovich, L, Buprion Versus Selective Serotonin Reuptake Inhibitors for Treatment of Depression, The Annals of Pharmacology, December, 2001, Volume 35, 1608 – 1613

[3] Clayton, A, Balon, R, The Impact of Mental Illness and Psychotropic Medications on Sexual Functioning, Journal of Sexual Medicine, 2009, 1200 – 1211

[4] Clayton, A, Alkis, A, Parikh, N, Votta, J, Sexual Dysfunction Due to Psychotropic Medications, Psychiatric Clinics of North America, 39, 2016, 427 – 463

[5] Ibid 4

[6] Ibid 4