For SSRI sexual side effects, adding buspirone or bupropion helps most; otherwise lower the dose or switch. Bupropion can even be given for anorgasmia without a mood disorder, and buspirone only helps if it is dosed properly.
What we do about it
For SSRI sexual side effects, buspirone and bupropion are the most helpful add-ons. Otherwise your choices are pretty much lowering the dose or switching the medication.
“For sexual side effects, main ones, buspar and bupropion. Those are going to be most helpful. and otherwise switching of the medication or lowering the dose are pretty much your choices”
57:09Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025 Bupropion is a great augmenting choice for people with low energy and anorgasmia from an SSRI. You can give it for anorgasmia even without a mood disorder, and it seems to help.
“great augmenting choice for people with energy issues and anorgasmia from the SRIs. You can actually give bupropion for anorgasmia in the absence of a mood disorder. It seems to help”
11:13Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025
Using buspirone for it
Do not underdose buspirone. Start at 15, be ready to go down if the patient is sensitive to it, and do not be afraid to take it to the max.
“Works for augmentation. Just don't under dose it. Start at 15. But be ready to go down if it's a patient who's more sensitive to it. And don't be afraid to take it to the max buspirone”
1:05:32Antidepressant Tier List: Psychiatrists Rank Depression Medications for MDDMay 2026 Buspirone was probably not being adequately dosed. You can titrate it fairly aggressively, but expect a little benefit, not the moon and the stars.
“What I found is that it was probably not being adequately dosed. You can be relatively aggressive with the titration of it. And you shouldn't expect it to give you the moon and the stars. It's got a little bit of benefit”
41:07Treating Depression: Practical Tips & Pearls for Anti-Depressant MedicationsJan 2025
Compared with others
Vilazodone and vortioxetine are the two antidepressants marketed as having slightly lower sexual side effects.
“I have seen that Vilazodone and Vortioxetine are the two meds that are marketed as slightly lower sexual side effects”
36:28Psychiatrist's Guide to Anxiety Medications: First Line to Last ResortJun 2025
It also comes up on
- BuspironeIt does not have sexual side effects, and it has very few long-term side effects compared with the other medications.
- SSRIsIf a patient does not want the weight or sexual side effects, bupropion is fine. Mirtazapine fits when sleep is a big issue and the patient is underweight or not concerned about weight.
- CitalopramSome patients tolerate citalopram better than escitalopram, against what we are taught. One patient felt very uncomfortable on escitalopram with bad sexual side effects, then did great on citalopram.
- EscitalopramKeep an open mind: some patients who felt terrible on escitalopram, with bad sexual side effects, do great on citalopram.
- OlanzapinePatients actually really like olanzapine. We tend to assume people will hate any drug that causes weight gain or sexual side effects, but patients report liking it.
From these episodes
Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.