A 29-year-old man with recurrent major depression develops distressing sexual dysfunction on sertraline and has gained 6 kg over three months. He requests a change. Which antidepressant is the most appropriate substitute given his complaints?
- A Paroxetine
- B Bupropion ✓
- C Mirtazapine
- D Venlafaxine
Correct answer: B. Bupropion
Explanation
Bupropion is a norepinephrine and dopamine reuptake inhibitor with negligible serotonergic activity, giving it the lowest rates of sexual dysfunction among antidepressants and a weight-neutral to weight-reducing profile, making it the standard switch option for SSRI-induced sexual dysfunction and weight gain. Paroxetine and venlafaxine carry high rates of both problems, and mirtazapine causes sedation and weight gain through H1 antagonism, worsening his complaints. Bupropion should be avoided only where seizure risk or an eating disorder is present.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
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