Sexual dysfunction bupropion

Adverse reactions with administration of bupropion include citation, dry mouth, insomnia, headache, nausea, constipation, anorexia, weight loss, and seizures. Fluoxetine administration may result in headache, activation of mania or hypomania, insomnia, anxiety, nervousness, nausea, vomiting, and sexual dysfunction. Trazodone administration may cause the following adverse reactions drowsiness, skin disorders, anger, hostility, anemia, priapism, nausea, and vomiting. Additional... 

After more than a decade of use, bupropion (24) is considered a safe and effective antidepressant, suitable for use as first-line treatment. In addition, it is approved for smoking cessation and seasonal affective disorder. It is also prescribed off-label to treat the sexual dysfunction induced by SSRIs. Bupropion is often referred to as an atypical antidepressant and has much lower affinity for the monoamine transporters compared with other monoamine reuptake inhibitors. The mechanism of action of bupropion is still uncertain but may be related to inhibition of dopamine and norepinephrine reuptake transporters as a result of active metabolites [71,72]. In a recently reported clinical trial, bupropion extended release (XL) had a sexual tolerability profile significantly better than that of escitalopram with similar re-... 

Sexual function One of the potential benefits of hypericum is the apparent reduced or lack of adverse effects upon sexual function, compared to pharmaceutical antidepressants. The SSRIs are particularly notorious for inhibition of sexual function, whereas antidepressants with dopaminergic actions (e.g., bupropion) do not, and may actually enhance sexual function (Rosen et al. 1999 Piazza et al. 1997). Anecdotal reports and the fact that there are no clinical reports of sexual dysfunction with hypericum is encouraging, but it remains to be tested empirically. 

Another widely practiced strategy to treat sexual dysfunction is the addition of pro-noradrenergic or pro-dopaminergic medications such as dopamine agonists or psychostimulants. The addition of bupropion is also believed to be effective but its mechanism of action remains obscure. 

In cases where the antidepressant response has not been resounding, we prefer switching antidepressants to avoid sexual side effects. The options include bupropion, nefazodone, and mirtazapine, which all effectively treat depression but produce minimal effects on sexual function. Sometimes, if a patient has responded well to one antidepressant but experiences a side effect such as sexual dysfunction, switching within the same class can be a useful approach. 

Labbate LA, Pollack MH Treatment of fluoxetine-induced sexual dysfunction with bupropion a case report. Ann Clin Psychiatry 6 13-15, 1994... 

Although the efficacy of tricyclic antidepressants in the treatment of unipolar depression is beyond reproach, the side-effect profile of these agents makes them less desirable as first-line therapeutic agents. Introduction of selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, paroxetine, sertraline, citalopram and fluvoxamine in the past decade has revolutionized the treatment of depression universally. The side-effect profile of SSRIs, such as nausea, diarrhea and sexual dysfunction, is considerably more benign than that of tricyclic drugs. Multiple controlled trials have proven the efficacy of SSRIs vs. placebo (Nemeroff, 1994). Recently, a number of SNRIs (serotonin and noradrenaline reuptake inhibitors) and so-called atypical antidepressants have been marketed that may have additional advantages over SSRIs, such as more rapid onset of action (venlafaxine. mirtazapine) and low sexual side-effect potential ( bupropion, nefazodone). Additionally, it appears that venlafaxine may be more efficacious in cases of treatment-refractory depression (Clerc et al., 1994 Fatemi et al., 1999). Finally, in a recent report (Thase et al., 2001),... 

Nefazodone, like bupropion, causes a lower incidence of sexual dysfunction (e.g., lower sexual drive, anorgasmia) than do the SSRIs and venlafaxine. 

These adverse effects bear some similarity to those of the SSRIs. Although these adverse effects rarely require discontinuation, aggravation of psychosis and seizures caused by this agent do (427, 462, 463 and 464). In contrast to the SSRIs and venlafaxine, bupropion usually does not cause sexual dysfunction. As such, bupropion may be an alternative for patients bothered by these adverse effects (465). Bupropion may also be a useful antidote for SSRI-induced sexual dysfunction (4 53, 455, 466, 467). 

Clayton AH, McGarvey EL, Warnock J, et al. Bupropion SR as an antidote to SSRI-induced sexual dysfunction. 40th Annual Meeting NCDEU, Boca Raton, Florida, 2000. 

Labbate LA, Grimes JB, Hines A, et al. Bupropion treatment of serotonin reuptake antidepressant-associated sexual dysfunction. Ann din Psychiatry 1997 9 241-245. 

Ashton AK, Rosen RC. Bupropion as an antidote for serotonin reuptake inhibitor-induced sexual dysfunction. J din Psychiatry 1998 59 112-115. 

In a prospective study, 47 patients who complained of SSRI-induced sexual dysfunction took amfebutamone (bupropion) 75-150 mg 1-2 hours before sexual activity (67). If this was unsuccessful they were titrated to a dosage of 75 mg tds on a regular basis. Amfebutamone improved sexual function in 31 patients (66%). Anxiety and tremor were the most frequently reported adverse events, and seven patients discontinued for this reason. However, it should be noted that more serious adverse events (panic attacks, delirium, and seizures) have been reported when amfebutamone (bupropion) and SSRIs are combined (59). 

Coleman CC, Cunningham LA, Foster VJ, Batey SR, Donahue RM, Houser TL, Ascher JA. Sexual dysfunction associated with the treatment of depression a placebo-con-trolled comparison of bupropion sustained release and sertraline treatment. Ann Clin Psychiatry 1999 11(4) 205-15. 

Kennedy SH, McCann SM, Masellis M, McIntyre RS, Raskin J, McKay G, Baker GB. Combining bupropion SR with venlafaxine, paroxetine, or fluoxetine a preliminary report on pharmacokinetic, therapeutic, and sexual dysfunction effects. J Clin Psychiatry 2002 63(3) 181-6. 

Even in the presence of a robust antidepressant effect, the burden of sexual dysfunction sometimes makes it impractical to continue with the same treatment. In these situations, the offending antidepressant is substituted for another one expected to have a much lower potential for causing sexual dysfunction (e.g., bupropion, mirtazapine, and nefazo-done). This approach is also fraught with certain risks, as the response to one antidepressant does not guarantee a response to the new one, and thus relapse may occur. It is important to remember that not all antidepressants work with equal efficacy in all patients, and many times responses are idiosyncratic. Also, the introduction of a different antidepressant may result in the appearance of a new set of side effects— intolerable agitation, excessive sedation, or fatigue, to cite some com-... 

Bupropion, sildenafil, vardenafll, ortadalafll for sexual dysfunction... 

For sexual dysfunction, can augment with bupropion, sildenafil, vardenafil, or tadalafil, or switch to a non-SSRI such as bupropion or mirtazapine... 

For sexual dysfunction, can augment with bupropion, sildenafil, vardenafll, fadalafll. 

Bupropion is another second-line agent, particularly for patients who are wary of the SSRIs negative impact on sexual dysfunction. Because it appears to relieve depression through a completely different mechanism than SSRIs, enhancing norepinephrine or dopamine, it is often administered to patients who fail SSRIs or exhibit a partial response. The most common side effects encountered with bupropion are insomnia, jitteriness, and nausea. Bupropion is contraindicated in patients with a history of seizures or eating disorders. 

Case Conclusion Given her favorable response to an SSRI in the past, sertraline would appear to be a logical choice for treatment of her latest episode, but her complaint of sexual dysfunction should be taken seriously, as this commonly leads to medication noncompliance. As all SSRI and venlafaxine are capable of inducing this side effect, bupropion is initiated and slowly titrated to effect. The activating properties of bupropion proved to be a notable benefit for this patient as her symptoms resolved within the first 3 weeks of receiving a therapeutic dose. 

B Sexual dysfunction is generally believed to be a dose-dependent side effect with SSRIs and may be relieved or prevented with lower doses. Although RH may run the risk of relapse at a lower dose, many patients will achieve a therapeutic response at lower doses. If this approach is unsuccessful, bupropion is an excellent antidote and may also provide additional antidepressant effects (i.e., augmentation). Sildenafil has actually been found to reverse SSRI-induced sexual dysfunction but is an expensive alternative with potential cardiovascular complications that should only be considered after other measures fail. 

Tricyclics modify peripheral sympathetic effects in two ways through blockade of norepinephrine reuptake at neuroeffector junctions and through alpha adrenoceptor blockade. Sedation and atropine-like side effects are common with tricyclics, especially amitriptyline. In contrast to sedative-hypnotics, tricyclics lower the threshold to seizures. The answer is (B). Selective serotonin reuptake inhibitors cause sexual dysfunction in some patients, with changes in libido, erectile dysfunction, and anorgasmia. Tricyclic antidepressants may also decrease libido or prevent ejaculation. Of the heterocyclic antidepressants bupropion is the least likely to affect sexual performance. The drug is also used in withdrawal from nicotine dependence. The answer is (B). 

A 35-year old woman taking fluoxetine 40 mg daily was given low-dose bupropion (100 mg daily) to treat fluoxetine-induced sexual dysfunction. Despite a good initial response, hypersexuality developed leading to discontinuation of bupropion. ... 

Chollet CAS, Andreatini R. Effect of bupropion on sexual dysfunction induced 1 fluoxetine a case report of hypersexuality. J Clin Psychiatry (2003) 64,1268-9. 

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