Adverse sexual side effects case - Wellbutrin

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This case sounds really awful. How terrible.

Bupropion-SR­ Induced Increased Libido and Spontaneous Orgasm

Dear Sir:

Although antidepressants have been commonly associated with sexual dysfunction, several case reports highlight unusual or exaggerated sexual responses, including spontaneous orgasm (1,2), with antidepressants. Bupropion, unlike tricylic or serotonin reuptake inhibitor antidepressants which commonly cause sexual dysfunction, has minimal sexual side effects (3) and may even have prosexual effects (4,5). I report on a patient treated with bupropion SR who experienced increased libido and a spontaneous second orgasm during sexual intercourse.

Mr A was a 37-year-old lawyer with a long history of attention-deficit disorder. There was no significant medical, neurological, or surgical history and no family or personal history of other mental illness or substance misuse. His mental status exam was unremarkable except for complaints of sustained attention problems. The attention-deficit disorder had been treated with methylphenidate and d-amphetamine with partial success, though these treatments were stopped because of medication-induced anxiety. There were no adverse sexual effects from the psychostimulants. He was then treated with bupropion SR, 150 mg 3 times daily, for his attention problems. He took no other medications. Over several weeks he noted improved concentration and attention but also noted bothersome increased libido, increased feeling on orgasm, and rare spontaneous partial erections during the day. There were no other signs or symptoms of hypomania. Six weeks after starting bupropion he experienced a surprise second orgasm during sexual intercourse. He reported that the initial ejaculation and orgasm were normal, but they were followed 5 seconds later by a spontaneous and pleasurable second ejaculation and orgasm. This had never happened previously. He stopped the medication out of concern for the increased libido. His libido returned to normal several days after stopping bupropion. Several months later he resumed bupropion SR, 150 mg twice daily, again experienced increased libido, and once more experienced an unexpected second orgasm during intercourse. He again stopped the bupropion. Libido returned to normal and he experienced no further altered orgasm. This case highlights that, like other antidepressants, bupropion SR may have unusual sexual side effects. The patient's experience of increased libido and alteration in orgasm with 2 trials of the drug suggests that the effects were caused by bupropion SR and were not a coincidence. The sexual experience did not otherwise seem part of drug-induced hypomania. The sexual side effects may be uncommon adverse effects, and it is unclear if they are dose-dependent. The mechanism of this possible adverse effect is unknown, though bupropion's central effects on norepinephrine or dopamine transmission may contribute. With the increased use of bupropion SR in the treatment of nicotine cessation, more cases of sexual adverse effects may come to light.

References

1. -Campayo J, Sanz-Carillo C, Lobo A. Orgasmic sexual experiences as a side effect of fluoxetine: a case report. Acta Psychiatr Scand 1995;91:69­70.

2. McLean JD, Forsythe RG, Kapkin IA. Unusual side effects of clomipramine associated with yawning. Can J Psychiatry 1983;28:569­70.

3. Gardner EA, ston JA. Bupropion: an antidepressant without sexual pathophysiological action. J Clin Psychopharmacol 1985;5:24­9.

4. Labbate LA, Pollack MH. Treatment of fluoxetine induced sexual dysfunction with bupropion. Ann Clin Psychiatry 1994;6:13­5.

5. Rowland DL, Myers L, Culver A, son JM. Bupropion and sexual function: a placebo controlled prospective study on diabetic men with erectile dysfunction. J Clin Psychopharmacol 1997;17:350­7.