Serious (“major”) depression is the most common mental illness. In severe cases, it leads to suicide, which takes 32,000 American lives a year. Among many other symptoms, depression typically destroys interest in sex.
Antidepressants save lives. Since 1987 when Prozac won FDA approval, its family of antidepressant medications, the selective serotonin reuptake inhibitors or SSRIs, has become the leading type of antidepressants medication. Other SSRIs include: Celexa, Lexapro, Luvox, Paxil, and Zoloft. SSRIs do a fine job of parting the black clouds.
The Sexual Downside of SSRIs
But in addition to such possible side effects as nausea, nervousness, insomnia, diarrhea, dry mouth, and tremor (hand shaking), the SSRIs have become notorious for causing sex problems: libido loss, weak orgasms, erection impairment, and difficulty experiencing orgasm or total inability to have them. Depending on the study, 50 to 80 percent of SSRI users report at least one sexual side effect. Many SSRI users insist they are willing to forego sexual satisfaction to escape the horror of depression. But others mourn SSRI-induced sex problems—and so do their lovers.
Few people know that another antidepressant, Wellbutrin (chemical name, bupropion), is as effective as the SSRIs, but much less likely to cause sexual side effects. In fact, several studies show that Wellbutrin is more likely to help than hurt sexuality.
“I’ve never seen a study showing that any SSRI is significantly superior to Wellbutrin as a treatment for depression,” says drug expert Joe Graedon, coauthor, with his wife, Teresa, of the People’s Pharmacy books, syndicated newspaper column, and radio program. “Its nonsexual side effects are usually mild and often transient. But in terms of sexual side effects, we’re talking night and day. The SSRIs send your sex life down the toilet, but sex problems with Wellbutrin are rare. It’s more likely to improve your sex life than hurt it.”
Wellbutrin’s Bad Luck
So why are so few people familiar with Wellbutrin? Why does it languish in the long shadow cast by the vastly more popular, yet sex-killing, SSRIs? The reasons involve a strange, ill-starred combination of bad luck, bad press, and drug industry prudery back in the days before Viagra proved that there was gold below the belt.
Back in the mid-1980s, when North Carolina-based Burroughs-Wellcome (now GlaxoWellcome) was working its way through the tedious process of demonstrating that Wellbutrin was safe and effective enough to win Food and Drug Administration approval, the company contracted with several laboratories to study the drug’s side effects.
One safety study raised a major red flag. At high doses, about twice the recommended maximum, the original formulation of Wellbutrin triggered seizures in four-tenths of 1 percent (0.4%) of those who took it, four people per 1,000. That may not sound like many, but it was 2 to 4 times the seizure risk of other antidepressants, and it doesn’t take too many car wrecks caused by seizures behind the wheel to cause sweaty palms at the FDA. The study results were reported in the medical trade press, and from coast to coast, you could almost hear prescription pads snapping shut.
Burroughs-Wellcome scrambled to save its multi-million dollar investment in Wellbutrin, and came up with a new slow-release (SR) formulation, now the standard prescription. According to the standard drug reference, Drug Facts and Comparisons, Wellbutrin-SR caused seizures in only one-tenth of one percent (0.1%) of users, comparable to the seizure risk of Prozac and Paxil, and lower than the risk associated with Zoloft (0.2%), Luvox (0.2%), and Celexa (0.3%). But the damage was done. Wellbutrin was tainted.
“Wellbutrin is an excellent antidepressant that has no more seizure potential then other antidepressants,” says Roberta May, M.A., director of the Office of Psychiatric Research and an assistant professor of psychiatry at the University of Alabama at Birmingham, “but many doctors still think it’s dangerous. The exact same drug is now prescribed to help people quit smoking, but GlaxoWellcome changed its name to Zyban to get out from under Wellbutrin’s bad reputation.”
Wellbutrin Surprise: Pro-Sexual Effects
At the same time Burroughs-Wellcome was hip-deep in damage control over the seizure report, the company also contracted with the Crenshaw Clinic in San Diego to study Wellbutrin’s sexual side effects. The Crenshaw Clinic (now closed) was operated by the late Theresa Crenshaw, M.D., a prominent sex-and-drug researcher, and coauthor of the medical text, Sexual Pharmacology. Crenshaw and her colleagues gave 60 men and women suffering from low libido and difficulty with orgasm either a placebo or Wellbutrin. Crenshaw knew that the SSRIs and most other antidepressants cause sex problems. She expected the placebo group’s sex problems to improve a little, and the Wellbutrin group’s to get worse. But a strange thing happened: In the placebo group, 3 percent reported improved sexual functioning, but in the Wellbutrin group, the figure was an astonishing 63 percent. “To our knowledge,” Crenshaw said in an interview before her death, “these results represent the first demonstration in a well-controlled clinical trial of an improvement in sexual dysfunction due to drug treatment.”
An astonished Crenshaw rushed to tell Burroughs-Wellcome that Wellbutrin was more than just another antidepressant. It looked promising as the first effective drug treatment for sex problems. Oddly, Burroughs-Wellcome showed no interest in what Crenshaw considered a potential medical breakthrough, not to mention, a commercial bonanza. “I knew they were preoccupied with the seizure business,” she said, “but still, you’d think they’d be interested in my findings. They weren’t. I got the feeling that they’d rather not know if their drug was a possible sex stimulant. I got the feeling they were prudes.”
“The drug companies have had a historical anti-sexual bias,” says Eli Coleman, Ph.D., professor and director of the Human Sexuality Program at the University of Minnesota in Minneapolis. “Of course, Viagra changed that,” but Crenshaw’s study took place a decade before the erection pill was approved.
“Burroughs-Wellcome wanted only one thing,” Graedon says, “to put the seizure problem behind them and persuade the FDA to approve Wellbutrin. I think they ignored Crenshaw’s findings for fear of rocking the FDA’s boat.”
In 1987, when Crenshaw’s study was published, the Graedons publicized Wellbutrin’s apparent prosexual effects in their column. But few people noticed, least of all doctors, who continued to get writer’s cramp from jotting SSRI prescriptions while largely ignoring an equally effective alternative that usually left sexuality intact, and sometimes improved it.
GlaxoWellcome spokeswoman Holly Russell says the company considered Wellbutrin an antidepressant, and was not particularly interested in its sexual effects beyond its low risk of sexual side effects. Once Wellbutrin was approved, company advertising simply said that compared with SSRIs, it was less likely to cause sex problems.
Wellbutrin Relieves SSRI-Induced Sex Problems
Wellbutrin languished both on pharmacy shelves and as a focus of research. But in the mid-1990s, as low-libido became recognized as a widespread problem, researchers showed renewed interest in Crenshaw’s report. Their studies, published in medical journals but ignored by the mass media, have confirmed Crenshaw’s findings.
* Researchers at the University of Alabama at Birmingham gave 107 depression sufferers one of four antidepressants: Wellbutrin or three SSRIs: Prozac, Paxil, or Zoloft. Among those taking the SSRIs, 73 percent complained of sex-impairing side effects. Only 14 percent of the Wellbutrin group reported sex problems, while 77 percent said the drug “improved sexual function.”
* University of Virginia researchers gave Wellbutrin or a placebo to 42 people suffering SSRI-induced sex problems. After four weeks, the Wellbutrin group reported significantly greater sexual desire and frequency.
* Researchers at the State University of New York tested Wellbutrin as an antidote for SSRI-induced sexual impairment in 47 depressed individuals who were told to take the drug an hour or two before sex. Wellbutrin successfully reversed SSRI-induced sex problems in 66 percent of them. The only significant side effect was tremor (in 15%).
* Belgian researchers reviewed these and many other studies and concluded that compared with SSRIs, Wellbutrin causes significantly fewer sexual side effects, and that the sexual side effects of SSRIs can often be reversed using Wellbutrin in addition.
Wellbutrin’s Sexual Effects in People Not Suffering Depression
Wellbutrin’s pro-sexual action in people with depression raised an intriguing question: Is the drug a sex stimulant in those who are not depressed, in the mentally healthy population? Several studies have addressed this.
* At Case Western Reserve, a team led by noted sex researcher R. Taylor Seagraves, M.D., Ph.D., gave Wellbutrin to 66 women, aged 23 to 65, who had experienced low or no libido for an average of 6 years. All 66 took a placebo for 6 weeks then the drug for 8 weeks. At the end of the placebo phase of the study, the group averaged 0.9 sexual encounters. But by the end of treatment with Wellbutrin, the figure more than doubled to 2.3. Sexual arousal also increased significantly, and number of sexual fantasies more than doubled (0.7 to 1.8). “Before starting treatment,” Seagraves said, “100 percent of the women were dissatisfied with their level of sexual desire, but by the end of the Wellbutrin phase, 40 percent felt satisfied.” The drug’s only signficant side effects were insomnia (18%), tremor (6%), and rash (6%).
* At the University of Alabama, a team led by psychiatrist Jack Modell, M.D., worked with 30 adults (20 women, 10 men), aged 21 to 54, who complained of low libido, poor sexual satisfaction, difficulty reaching orgasm, and among the men, premature ejaculation and erectile dysfunction. The researchers asked the participants to have sex at least twice a week for the duration of the study, and to keep detailed diaries of their erotic experiences. For three weeks, the participants had sex with no treatment at all to establish baselines. Then for three weeks, they took a placebo, followed by three weeks of Wellbutrin. The placebo improved sexual function over baseline, but Wellbutrin treatment “significantly improved” sexual functioning over the placebo. The women recorded highly statistically significant improvement in ability to experience orgasm and orgasmic pleasure, and the men reported highly significant improvement in ability to raise and maintain erection and experience orgasm/ejaculation. The only sex problem that did not respond to Wellbutrin was premature ejaculation. Wellbutrin side effects were mild–some headache, anxiety, irritability, and insomnia–but no one dropped out because of them.
* Diabetes increases risk of erectile dysfunction in men. Researchers at Valparaiso University in Indiana gave Wellbutrin to 14 nondepressed diabetic men with erection problems. After 10 weeks, they showed improved sexual functioning.
* Case Western scientists gave Wellbutrin to women with no diagnosed medical condition except low or no sexual desire. “Wellbutrin significantly increased sexual arousal, orgasm completion, and sexual satisfaction.”
* Wellbutrin is not considered a treatment for general sexual dysfunction, and as far as I can tell, few physicians prescribe it for sex problems. But the University of Minnesota’s Coleman says: “There is now enough research to suggest that Wellbutrin might be a useful treatment for sexual dysfunction.”
If You’re Taking an SSRI…
If you’re currently taking an SSRI and suffering sex problems because of it, ask your doctor about the possibility of switching to Wellbutrin, or of taking a low dose of Wellbutrin (75 mg) in addition to your SSRI two hours before sex to mitigate SSRI-induced sexual impairment.
If you switch to Wellbutrin, or add it to your treatment regimen, its side effects are similar to those caused by the SSRIs. “But there’s somewhat more likelihood of tremor,” May explains. “Tremors usually go away after a while, but at first they can be scary.”
Because Wellbutrin is already an approved antidepressant, doctors are free to prescribe it for sex problems without the FDA’s specific approval for that indication. But approval would allow advertising and would certainly boost sales, especially to women, who have not shown benefit from erection medications, and to men with sex problems unrelated to erection.
Is Wellbutrin an Aphrodisiac?
So far, Wellbutrin has not been studied in normal, healthy people who are not depressed and don’t have sex problems. As a result, there’s no way to know if it’s generally sex-enhancing, or to use a somewhat more loaded term, an aphrodisiac. No one interviewed for this article called Wellbutrin an aphrodisiac. But some speculated that it might be.
“If it is,” Graedon explains, “you can’t drop it into someone’s martini and an hour later have them beg you for sex. It takes several weeks of regular use for Wellbutrin’s prosexual effects to appear. At this point, it’s most appropriate as a treatment for sex problems in those under the care of a physician or sex therapist.”
Ashton, A.K. et al. “Bupropion as an Antidote for Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction,” Journal of Clinical Psychiatry (1998) 59:12.
Clayton, A.H. et al. “A Placebo-Controlled Trial of Bupropion SR as an Antidote for Selective Serotonin Reuptake Inhibitor-Induced Sexual Dysfunction,” Journal of Clinical Psychiatry (2004) 65:62.
Crenshaw T.L. et al. “Pharmacologic Modification of Psychosexual Dysfunction,” Journal of Sex and Marital Therapy (1987) 13:239.
Demyttenaere, K. and L. Jaspers. “Review: Bupropion and SSRI-Induced Side Effects,” Journal of Psychopharmacology (2008) 22:792.
Labbate, L.A. et al. “Bupropion Treatment of Serotonin Reuptake Antidepressant-Associated Sexual Dysfunction,” Annals of Clinical Psychiatry (1997) 9:241.
Modell, J.G. et al. “Effect of Bupropion SR on Orgasmic Sysfunction in Nondepressed Subjects: A Pilot Study,” Journal of Sex and Marital Therapy (2000) 26:231.
Modell, J.G. et al. “Comparative Sexual Side Effects of Bupropion, Fluoxetine, Paroxetine, and Sertraline,” Clinical Pharmacology and Therapeutics (1997) 61:476.
Rowland, D.L. et al. “Bupropion and Sexual Function: A Placebo-Controlled Prospective Study of Diabetic Men with Erectile Dysfunction,” Journal of Clinical Psychopharmacology (1997) 17:350.
Safarinejad, M.R. “Reversal of SSRI-Induced Female Sexual Dysfunction by Adjunctive Bupropion in Menstruating Women: A Double-Blind, Placebo-Controlled, Randomized Trial,” Journal of Psychopharmacology (2010) epub ahead of print.
Seagraves, R.T et al. “Buproion Sustained Release for the Treatment of Hypoactive Sexual Desire Disorder in Premenopausal Women,” Journal of Clinical Psychopharmacology (2004) 24:339.
Seagraves, R.T. et al. “Bupropion SR for Treatment of Hypoactive Sexual Desire in Nondepressed Women,” Journal of Sex and Marital Therapy (2001) 27:303.