Wonderful Wellbutrin?

Most antidepressants suppress sex drive, but some new evidence suggests this one might be different.

By Michael Castleman

Sep 26, 2000 | In the dozen years since it was first introduced, Prozac and its close chemical relatives, the selective serotonin reuptake inhibitors, or SSRIs (Paxil, Zoloft, Luvox and Celexa), have become the nation's most popular antidepressants. They do a great job of parting the black clouds of depression, and many people swear that SSRIs have improved their lives dramatically.

But in addition to typical antidepressant side effects -- nausea, nervousness, insomnia, diarrhea, dry mouth and tremor (hand shaking) -- the SSRIs have become notorious for causing sex problems: libido loss, weak orgasms, difficulty in reaching or inability to reach orgasm and, in men, erection impairment. 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 forgo sexual satisfaction to escape from the horrors of depression. But others are unhappy about SSRI-induced sex problems.

Unfortunately, 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. And most don't know that several studies have shown that Wellbutrin has sex-enhancing effects.

"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 syndicated radio program. "And like the SSRIs', Wellbutrin's nonsexual side effects are pretty 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."

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 answer involves 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. Two recent studies may begin to turn things around (except for the fact that they have received no press coverage).

In the mid-1980s, when Burroughs-Wellcome (now GlaxoWellcome) in North Carolina 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. (Wellbutrin is not an SSRI and is chemically unrelated to every other antidepressant medication; researchers are still not sure how it works.)

One safety study raised a major red flag. At high doses, about twice the recommended maximum, the original formulation of Wellbutrin triggered seizures in 0.4 percent of those who took it -- four people per 1,000. That may not sound like much of a hazard, but it was two to four 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 you could almost hear the prescription pads snapping shut from coast to coast.

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