What is the best antidepressant for erectile dysfunction? (3+ options)
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In this article, we will discuss the best antidepressants to take if you have erectile dysfunction (ED). We will also talk about antidepressants which are less likely to cause sexual side effects in general and antidepressants that can worsen ED.
What is the best antidepressant for erectile dysfunction?
Wellbutrin (bupropion) is considered the best antidepressant for people struggling with erectile dysfunction (ED). Wellbutrin is an atypical antidepressant which is often considered for people who have ED (1).
Some people may develop ED after trying other antidepressants, like SSRIs and SNRIs, which are known for causing sexual side effects. Such people often switch to Wellbutrin as this antidepressant can reverse sexual side effects caused by typical antidepressants which are commonly prescribed.
Wellbutrin may also help some individuals who have ED unrelated to any medication. It is also considered one of the best antidepressants for energy and motivation, and can also help people lose weight (2).
However, Wellbutrin has its pros and cons, and it may not work well for everyone. If you have ED comorbid with depression, talk to your doctor about it. If Wellbutrin is the right choice of medication for you, it will surely help you with your ED-related symptoms.
If you are on any other antidepressant, you should again consult your doctor instead of trying to switch on your own.
Antidepressants need to be tapered off, and you can’t just stop them abruptly. So, if you think your current antidepressant is triggering or worsening your ED, your doctor will safely taper it off and switch you to Wellbutrin.
What does research suggest?
Several research studies have discussed the effects of Wellbutrin on sexual functions. One research study investigated the effects of bupropion on non-depressed diabetic men with erectile issues. Fourteen guys took part in a 10-week study (3).
They were asked to fill out questionnaires about how things were going in the bedroom every day and week, and a team of experts rated different aspects of their sex lives every two weeks.
The results showed that bupropion did not affect sexual functions in any shape or form. In fact, it seemed like some aspects of their sex lives got a bit better (3).
Another research study was conducted including 13 men who took bupropion for two weeks. The results did not show any sexual dysfunction. The number of erections, how long they lasted, and penile stiffness were not affected by the drug (4).
Another study investigated the effects of bupropion in people struggling with depression-induced sexual dysfunction. Depression is a common mental health issue, affecting about 16.6% of people, and it often messes with various parts of life (5).
One significant area is sexual dysfunction (SD), hitting around 40-45% of adult women and 20-30% of adult men (5). The study indicated that bupropion could be a good antidepressant for such people, as other typical antidepressants may worsen the symptoms of ED and related sexual issues.
What other antidepressants can be used in people with ED?
There are some other antidepressants which may also be used for ED if Wellbutrin is not the right choice of medication for a certain individual. These include:
Mirtazapine (Remeron)
Mirtazapine is another atypical antidepressant like bupropion, meaning it does not work as most typical antidepressants do (6). Mirtazapine is considered less likely to cause sexual side effects, including ED.
So, if for some reason, you can’t take bupropion – mirtazapine could be a good option. Mirtazapine is also a sedative antidepressant and can help people who experience insomnia with other typical antidepressants or bupropion.
Vilazodone (Vibrryd)
Vilazodone also comes under the category of atypical antidepressants and is less likely to cause or worsen pre-existing ED. However, it is also associated with some side effects, so it might not be the best option for every one (7).
Vortioxetine (Trintellix)
Vortioxetine is another atypical antidepressant which does not work like commonly prescribed antidepressants, such as SSRIs or SNRIs (8). It is also not known for causing sexual side effects and the incidence of ED is quite low.
It is important to note that these antidepressants are prescription medications and should never be taken without consulting with your provider. If you feel like your current antidepressant isn’t doing much for you or if it is worsening your condition, please reach out to your doctor.
What antidepressants should be avoided in people with ED?
Most commonly prescribed antidepressants like SSRIs or SNRIs are considered well-tolerated, but these should be avoided or prescribed carefully in the case of depression comorbid with ED.
This is because these medications are known for causing sexual side effects, especially SSRIs (9). It is important to note that not everyone experiences sexual side effects when taking these meds, but the incidence is higher compared to the antidepressants we have discussed earlier.
Also, healthy individuals are at a lower risk of antidepressant-induced ED or worsening of ED compared to those who struggle with this condition irrespective of the medication.
Patient-specific details are crucial when it comes to prescribing antidepressants or any other medication for that matter.
Some medications with documented sexual side effects are mentioned in the table below:
| Classes of antidepressants | Examples |
| Selective serotonin reuptake inhibitors (SSRIs) | Sertraline, fluoxetine, paroxetine, escitalopram, citalopram. |
| Serotonin-norepinephrine reuptake inhibitors (SNRIs) | Duloxetine, venlafaxine, desvenlafaxine. |
| Tricyclic antidepressants (TCAs) | Imipramine, desipramine, nortriptyline, amitriptyline. |
Being a pharmacist, I have come across many cases of antidepressant-induced sexual side effects or worsening of pre-existing conditions like ED.
Sometimes, medication intervention is required, where your doctor recommends some add-on medications to manage the symptoms of ED and to improve the quality of life. However, people are different and respond differently to meds.
I recommend keeping a close eye on your side effects and monitoring your sexual functions whenever you start taking any antidepressant. If you notice changes in your sexual function, even minor ones, discuss them with your provider to prevent your symptoms from getting any worse.
Remember, your health should be your priority.
References
- The Food and Drug Administration (FDA). HIGHLIGHTS OF PRESCRIBING INFORMATION. WELLBUTRIN® (bupropion hydrochloride) tablets, for oral use. Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018644s052lbl.pdf
- Huecker MR, Smiley A, Saadabadi A. Bupropion. 2023 Apr 9. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29262173. https://www.ncbi.nlm.nih.gov/books/NBK470212
- Rowland DL, Myers L, Culver A, Davidson JM. Bupropion and sexual function: a placebo-controlled prospective study on diabetic men with erectile dysfunction. J Clin Psychopharmacol. 1997 Oct;17(5):350-7. doi: 10.1097/00004714-199710000-00003. PMID: 9315985. https://pubmed.ncbi.nlm.nih.gov/9315985/#:~:text=Results%20indicated%20that%20neither%20subjective,was%20unaffected%20by%20bupropion%20administration.
- Labbate LA, Brodrick PS, Nelson RP, Lydiard RB, Arana GW. Effects of bupropion sustained-release on sexual functioning and nocturnal erections in healthy men. J Clin Psychopharmacol. 2001 Feb;21(1):99-103. doi: 10.1097/00004714-200102000-00018. PMID: 11199957. https://pubmed.ncbi.nlm.nih.gov/11199957/
- Pereira VM, Arias-Carrión O, Machado S, Nardi AE, Silva AC. Bupropion in the depression-related sexual dysfunction: a systematic review. CNS Neurol Disord Drug Targets. 2014;13(6):1079-88. doi: 10.2174/1871527313666140612112630. PMID: 24923342. https://pubmed.ncbi.nlm.nih.gov/24923342/
- Jilani TN, Gibbons JR, Faizy RM, Saadabadi A. Mirtazapine. 2023 Aug 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30085601. https://www.ncbi.nlm.nih.gov/books/NBK519059
- McCormack PL. Vilazodone: a review in major depressive disorder in adults. Drugs. 2015 Nov;75(16):1915-23. doi: 10.1007/s40265-015-0490-y. PMID: 26496736. https://pubmed.ncbi.nlm.nih.gov/26496736/
- Sowa-Kućma M, Pańczyszyn-Trzewik P, Misztak P, Jaeschke RR, Sendek K, Styczeń K, Datka W, Koperny M. Vortioxetine: A review of the pharmacology and clinical profile of the novel antidepressant. Pharmacol Rep. 2017 Aug;69(4):595-601. doi: 10.1016/j.pharep.2017.01.030. Epub 2017 Feb 1. PMID: 28499187. https://pubmed.ncbi.nlm.nih.gov/28499187/
- Gregorian RS, Golden KA, Bahce A, Goodman C, Kwong WJ, Khan ZM. Antidepressant-induced sexual dysfunction. Ann Pharmacother. 2002 Oct;36(10):1577-89. doi: 10.1345/aph.1A195. PMID: 12243609. https://pubmed.ncbi.nlm.nih.gov/12243609/#:~:text=Selective%20serotonin%2Dreuptake%20inhibitors%20(SSRIs,of%20treatment%2Dinduced%20sexual%20dysfunction.
