The Antidepressant Drug Best for Sex

Depression is a very common, potentially fatal illness (suicide). Antidepressants usually help, but they have a distressing downside, sexual side effects: loss of erotic interest, arousal and erection problems, and particularly trouble having orgasms. Fortunately, one antidepressant rarely causes sexual side effects, Wellbutrin (bupropion).

Wellbutrin is just as effective as the most popular class of antidepressants, the SSRIs (Prozac, Paxil, Zoloft, Celexa, Lexapro, Luvox). Its nonsexual side effects are no worse, and it’s unlikely to cause sexual side effects. But doctors rarely prescribe it. Therein hangs a tale of bad luck and drug company prudery in the era before Viagra.

In the mid-1980s, North Carolina-based Burroughs-Wellcome (now Glaxo Wellcome) contracted with several laboratories to study Wellbutrin’s side effects in hopes of winning Food and Drug Administration approval. One study raised a red flag. At high doses, Wellbutrin’s original formulation triggered seizures in four-tenths of 1 percent of users, four people per 1,000. That’s not many, but it was three times the seizure risk of other antidepressants, and the FDA has nightmares about car wrecks caused by seizures behind the wheel. The study results were reported in the medical press, and suddenly, doctors viewed Wellbutrin as too risky to prescribe.

Burroughs-Wellcome scrambled and came up with a new slow-release (SR) formulation that causes seizures in only one-tenth of 1 percent of users, comparable to the seizure risk of Prozac and Paxil, and lower than the risk associated with Zoloft, Luvox, and Celexa. But the damage was done. Wellbutrin was tainted, and despite a massive advertising campaign, doctors did not change their minds. (The name, Wellbutrin, was so toxic that when the drug was shown to help smokers quit, it was released under a different name, Zyban.)

Meanwhile, around the time of the seizure scare, a dozen years before Viagra’s approval, Burroughs-Wellcome also contracted with a noted sex researcher, Theresa Crenshaw, M.D., (now deceased) to investigate Wellbutrin’s side effects. Crenshaw, the coauthor of the medical text, Sexual Pharmacology, found that it caused fewer sexual side effects than other antidepressants—and that some users reported sexual enhancement. “Our study,” Crenshaw told me in an interview shortly before her death, “was the first well-controlled clinical trial to demonstrate an improvement in sexual function due to drug treatment.”

An astonished Crenshaw rushed to tell Burroughs-Wellcome that Wellbutrin was more than just another antidepressant. It was a potential bonanza, a pill that, for some, improved sex. Oddly, Burroughs-Wellcome showed no interest. Or not so oddly. Before Viagra, the drug industry had always steered clear of anything sexual. In Crenshaw’s words, “They were prudes.”

Wellbutrin languished both on pharmacy shelves and as a focus of research. But in the mid-1990s, low libido became recognized as a problem, and researchers showed renewed interest in Crenshaw’s earlier report. Several more studies showed that Wellbutrin caused fewer sexual side effects than SSRIs and that SSRI users who also took some Wellbutrin reported fewer sexual side effects and better sexual functioning.

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 ask about taking a low dose of Wellbutrin (75 mg) in addition to your SSRI two hours before sex. Unfortunately, few doctors know that Wellbutrin is an effective substitute for SSRIs, one that causes few sexual side effects and may even enhance sexual satisfaction.

If you switch to Wellbutrin or add it to your treatment regimen, the only unusual side effects are a somewhat higher risk of tremors, which can be scary. Fortunately, after a few months, tremors usually subside.