COMPARATIVE SEXUAL SIDE-EFFECTS OF BUPROPION, FLUOXETINE, PAROXETINE,AND SERTRALINE

Objective: To investigate patient reported prosexual side effects of t he aminoketone antidepressant bupropion (INN, amfebutamone) and to com pare directly the sexual side effects of bupropion and the selective s erotonin reuptake inhibitor (SSRI) antidepressants fluoxetine, paroxet ine, and sertraline. Methods: One hundred seven psychiatric outpatient respondents receiving current treatment with one of the above antidep ressants anonymously completed questionnaires that allowed reporting o f both decreases and increases in sexual function. The main outcome me asures were antidepressant-associated changes in Libido, arousal, dura tion of time from arousal to orgasm, intensity of orgasm, and duration of orgasm relative to that experienced before the onset of the patien ts' psychiatric illnesses. Results: Bupropion-treated patients reporte d significant increases in libido, level of arousal, intensity of orga sm, and duration of orgasm beyond levels experienced premorbidly. The three SSRIs to an equal degree significantly decreased libido, arousal , duration of orgasm, and intensity of orgasm below levels experienced premorbidly. Overall, 27% of the SSRI-treated patients had no adverse sexual side effects; in contrast, 86% of patients treated with buprop ion had no adverse sexual effects, and 77% of bupropion-treated patien ts reported at least one aspect of heightened sexual functioning. Conc lusions: SSRI-induced adverse sexual effects appear to be the rule rat her than the exception and may be substantially underreported unless p atients are specifically asked about the effects of these medications on various aspects of sexual function. In contrast, prosexual effects were reported by the majority of patients treated with bupropion. The findings are reviewed in Light of the neurochemistry of these agents a nd the sexual response.