Bupropion and sexual function: a placebo-controlled prospective study on diabetic men with erectile dysfunction

Review: Bupropion and SSRI-induced side effects

Selective serotonin reuptake inhibitors (SSRIs) are a first line treatment option for millions of patients, due to the positive balance between efficacy and tolerability. However, some side effects associated with their use, can impair quality of life and compliance with treatment. This paper reviews the prevalence of sexual dysfunction, weight gain and emotional detachment during SSRI treatment, the profile of bupropion for each of these events and the ability of bupropion to reverse them. Double-blind trials, open-label trials and anecdotical reports derived from Medline were included. First, there is robust evidence that SSRIs can induce sexual side effects and that bupropion causes less sexual dysfunction than SSRIs. There is limited, mainly open-label evidence that bupropion can reverse SSRI-induced sexual side effects. Second, there is good evidence that long-term treatment with some SSRIs can result in weight gain and that long-term treatment with bupropion can result in a small weight loss. There is only anecdotical evidence that bupropion can reverse SSRI-induced weight gain. Third, treatment with SSRIs has been associated with ;emotional detachment', although controversy exists about this concept. No data are available on the profile of bupropion for ;emotional detachment' or for the reversal of SSRI-induced ;emotional detachment' by bupropion-addition.

An open-label, fixed-dose study of bupropion effect on sexual function scores in women treated for breast cancer

BACKGROUND

Sexual morbidity after chemotherapy and hormonal therapy for breast cancer can seriously affect patients' quality of life. Bupropion is an antidepressant that has been reported to increase libido.

OBJECTIVE

To investigate the improvement of sexual function in female breast cancer patients using bupropion.

PATIENTS AND METHODS

We performed an 8-week open trial using bupropion in women diagnosed with breast cancer who had received chemotherapy and were currently receiving adjunctive hormonal therapy. The Arizona Sexual Experience Scale (ASEX) was used. The ASEX scale includes five questions that evaluate sexual function in the following areas: libido, excitability and ability to reach orgasm. Women received oral Bupropion 150 mg/daily for 8 weeks and were evaluated prior to the initiation of the study and again during Weeks 4 and 8.

RESULTS

Twenty patients were included in the study. At the beginning of the study, the mean ASEX score was 23.45 [21.67-25.24] 95% CI. After 4 weeks of treatment, we observed a reduction in the mean ASEX score that persisted until the end of the study, at eight weeks: 18.45 [16.59-20.31] 95% CI (P = 0.0003) and 18.95 [16.60-21.30] 95% CI (P = 0.0024), respectively.

CONCLUSION

In this non-controlled open trial bupropion 150 mg/daily was associated with improved sexual function in women receiving adjuvant systemic treatment for breast cancer.

Relationship of depression to diabetes types 1 and 2: epidemiology, biology, and treatment

This article reviews the rapidly accumulating literature on the relationship between mood disorders and diabetes mellitus. Recent studies have demonstrated that depression and its associated symptoms constitute a major risk factor in the development of type 2 diabetes and may accelerate the onset of diabetes complications. Since the mid-1980s, multiple longitudinal and cross-sectional studies have scrutinized the association of diabetes with depressive symptoms and major depression. Utilizing the search terms depressive disorders, psychiatry, diabetes, and pathophysiology in MEDLINE searches (1966-2003), this article reviews studies investigating pathophysiological alterations related to glucose intolerance and diabetes in depressed patients. The few randomized, controlled studies of treatment of depression in patients with diabetes are also described. Short-term treatment of depression in patients with diabetes improves their dysphoria and other signs and symptoms of depression. Future research will confirm whether response to psychotherapy and/or psychopharmacologic treatment improves glucose control, encourages compliance with diabetes treatment, and perhaps even increases longevity.

Vibrational assignment of 4-amino-3-penten-2-one

The infrared and Raman spectra of 4-amino-3-penten-2-one and its two deuterated analogous have been measured. Comparison between the spectra recorded with two techniques, density functional theory (DFT) calculations and the spectral behavior upon deuteration was used for assignment of the vibrational spectra of the titled compound. DFT suggests a relatively strong intramolecular bent hydrogen bond with N...O distance in the range of 2.64-2.67 A, which is in agreement with the observed vNH at 3180 cm(-1). Existence of an intermolecular hydrogen bond is also shown in both solid and solution phases. The spectroscopic data support the enamine structure for this compound rather than imine structure.

Bupropion-sustained release as a treatment for SSRI-induced sexual side effects

Twenty-four subjects treated with serotonin reuptake inhibitors for a depressive disorder who had new-onset sexual side effects coincident with antidepressant treatment were treated with escalating doses of bupropion SR up to 300 mg daily for 7 weeks. Global response rates were 46% for women and 75% for men. All sexual side effects improved in response to bupropion SR in both men and women with no differential effect on any one sexual side effect. Most of the improvement (more than 50%) occurred within the first 2 weeks and at low dose (100-200 mg/day). When prescribed in an open fashion, bupropion SR appeared to be effective in treating all the major categories of sexual side effects.

Effects of bupropion sustained-release on sexual functioning and nocturnal erections in healthy men

Many antidepressants are known to cause adverse sexual effects. Bupropion is an antidepressant with fewer reported adverse sexual effects. Studies of sexual side effects are often confounded by psychiatric and medical conditions affecting sexual function. In this study, the effects of bupropion on subjective and objective sexual functioning were measured in healthy men. Thirteen men without psychiatric or medical illness completed a 2-week, placebo-controlled, double-blind, crossover trial of bupropion sustained-release 300 mg/day. Subjects had a 1-week washout period between trials. Sexual function was measured using a validated, self-administered questionnaire and the RigiScan, an instrument measuring nocturnal penile tumescence and rigidity. No differences were found in self-reported sexual function, number of erections, total erection time, or penile rigidity in subjects taking bupropion compared with those taking placebo or baseline. These findings support that bupropion does not have subjective adverse sexual side effects and does not affect nocturnal erections in healthy men.

Effect of bupropion-SR on orgasmic dysfunction in nondepressed subjects: a pilot study

The objective of this study was to determine whether the aminoketone antidepressant bupropion has beneficial effects in orgasmic dysfunction.

DESIGN

Single-blind, sequential treatment order of three weeks each: placebo, bupropion-SR 150 mg/day, bupropion-SR 300 mg/day.

SUBJECTS

Nondepressed women (n = 20) and men (n = 10) having nonphysiologic orgasmic delay or inhibition.

MAIN OUTCOME MEASURES

Reported difficulty or delay in achieving orgasm, satisfaction with orgasm and erectile function, and subjective impressions of drug effect.

RESULTS

In the women, there were significant improvements relative to baseline (p < .01) on both doses of bupropion-SR in all measured aspects of sexual function, and significant improvements relative to placebo (p < .05) in overall sexual satisfaction on both doses and satisfaction with intensity of orgasm on 150 mg/day (300 mg/day, p = .10). In the men, significant improvements over baseline (p < .01) were observed with both doses in overall sexual satisfaction, ability to achieve an erection, and delay in reaching orgasm/ejaculation; significant improvements relative to placebo (p < .05) were observed in overall sexual satisfaction on both doses, ability to achieve erection on 150 mg/day, and delay in orgasm/ejaculation on 150 mg/day. Seventy percent of subjects reported improvement in libido, arousal, or orgasmic function during bupropion administration.

CONCLUSIONS

Bupropion-SR may be a useful agent for treating orgasmic delay and inhibition, and possibly disorders of sexual arousal. The results argue against bupropion's apparent prosexual effect in depressed patients being simply a result of its antidepressant activity.

Penile sensitivity in men: a composite of recent findings

OBJECTIVES

To present, in standardized form, age- and dysfunction-related data from 13 studies on vibrotactile penile epiglandal thresholds in men to allow cross-study comparisons, a capability previously prevented by the use of varying methods and units of measurement.

METHODS

On the basis of the summarization and standardization of multiple studies located through online searches of bibliographic data bases, penile sensory thresholds were first plotted as a function of age, and then as a function of dysfunctional or disease status. In a third plot, both age- and dysfunction-related differences were illustrated within a single plot.

RESULTS

An increasing curvilinear threshold as a function of age was confirmed in the pattern derived from multiple studies. Furthermore, even when controlling for age, penile thresholds of men with erectile dysfunction lay one or more standard deviations above those of sexually functional counterparts, and this deviation became even higher during penile tumescence. When relationships among age, dysfunctional/disease status, and penile threshold were examined simultaneously, potential compounding effects of age and dysfunction emerged.

CONCLUSIONS

From a research perspective, standardized information on penile vibrotactile thresholds will facilitate ongoing study aimed at elucidating the role of penile sensitivity to both erectile and ejaculatory response. From a clinical perspective, standardized information on populations of sexually functional and dysfunctional men may assist in a preliminary differential diagnosis.