A 34-year-old man with recurrent major depression is clinically improved on sertraline 150 mg/day but finds erectile dysfunction and delayed ejaculation intolerable and insists he will stop the medication otherwise. He responds well to this dose and wishes to remain on it. What is the best next step?
- A Cross-taper to paroxetine
- B Add bupropion as an adjunct ✓
- C Stop sertraline and start mirtazapine
- D Reassure him that sexual side effects always resolve spontaneously
Correct answer: B. Add bupropion as an adjunct
Explanation
Bupropion, a norepinephrine-dopamine reuptake inhibitor, has minimal sexual side effects and has evidence for improving SSRI-induced sexual dysfunction when added to a working SSRI, preserving the therapeutic benefit already achieved. Switching to another SSRI such as paroxetine is unlikely to help since all SSRIs share this adverse effect class-wide. Sexual dysfunction often persists rather than resolving spontaneously, so simple reassurance risks losing a responding patient to nonadherence.
Reference: Stahl's Essential Psychopharmacology, 5th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.