A Systematic Review of the Use of Bupropion For Hypoactive Sexual Desire Disorder in Premenopausal Women

Objective: To assess the efficacy of bupropion therapy for hypoactive sexual desire disorder (HSDD) in women. Methods: A systematic review was performed utilizing the standard databases. Data were abstracted for study quality, characteristics, and outcomes. Due to the small number of studies and lack of consistently reported outcomes, a meta-analysis was not performed. Results: Two studies (289 women) met inclusion criteria. While one study had low risk of bias, the other had areas of high risk of bias. Both trials reported improvement in sexual function domains with treatment ranging from 12 weeks to 112 days. Conclusions: Despite two trials demonstrating benefit with bupropion treatment for premenopausal women with HSDD, the evidence is limited and not of adequate quality to recommend the therapy. More trials are needed in this area. Corresponding author: David M. Haas, MD, MS Dept. of OB/GYN, 550 N University Blvd, UH 2440, Indianapolis, IN 46202 (317)880-3959 (office), dahaas@iupui.edu DOI : 10.14302/issn.2381-862X.jwrh-14-546 Freely Available Online www.openaccesspub.org | JWRH CC-license DOI : 10.14302/issn.2381-862X.jwrh-14-546 Vol-1 Issue 1 Pg. no.15 INTRODUCTION Female sexual dysfunction is a prevalent problem worldwide with reported rates of 10-30% . Hypoactive sexual desire disorder (HSDD) is a common form of sexual dysfunction affecting females more often than males at rates of 30% and 15%, respectively 2, . HSDD is defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) as “the persistent or recurrent deficiency or absence of sexual fantasies/thought, and/or desire for sexual activity that causes personal distress or interpersonal difficulties”. It is not uncommon for women with HSDD to also have concomitant sexual arousal and/or orgasmic disorders . Additionally, HSDD and low sexual desire in general are believed to be underestimated by health care providers and are associated with decreased relationship satisfaction and distress for many women and their partners 1, . Furthermore, impaired sexual desire has been shown to be associated with depressed mood. While studies have shown improvement in sexual function with relief of depressive symptoms, additional investigation into the psychological and physiological effects of antidepressants has provided evidence of antidepressant-induced sexual dysfunction as an adverse effect of many of these medications . Despite ongoing research into female sexual dysfunction and HSDD, the exact etiology of these disorders is yet to be determined. There have been many trials conducted to determine the efficacy of various therapies in the treatment of HSDD. Decreased androgen levels have been shown to be associated with a decline in libido. Testosterone therapy (oral, transdermal patch, or topical) has been investigated through randomized controlled trials (RCTs) indicating statistically significant improvement in sexual desire . Testosterone transdermal patches have been approved for HSDD treatment in Europe. However, the U.S. Food and Drug Administration did not approve testosterone therapy for the treatment of HSDD due to the unknown long term adverse events (Moynihan 2004). In addition to testosterone therapies, investigations of genital vasodilators, dopaminergic therapies, estrogen therapies, and melanocortin receptor-acting bremelanotide have been conducted 1, . However, despite these investigations, there continues to be no FDA approved treatment for HSDD in the United States. Bupropion is a centrally-acting medication that is currently approved for use in the treatment of major depressive disorder, seasonal affective disorder, and smoking cessation (Bupriopion package insert 2014). The exact mechanism of action of bupropion has yet to be determined, however, it is believed to act centrally on both dopaminergic and norepinephrine systems with no serotonergic action . In addition to its role in mood improvement, bupropion has been shown to be effective in the reversal of SSRI-induced sexual dysfunction when supplemented to current therapy as well as a (Continued on page 16) Freely Available Online www.openaccesspub.org | JWRH CC-license DOI : 10.14302/issn.2381-862X.jwrh-14-546 Vol-1 Issue 1 Pg. no.16 substitution therapy . In addition to treatment of iatrogenic sexual dysfunction, study results indicate prosexual effects through the use of bupropion 12, . The objective of this study was to systematically review the data regarding bupropion treatment for HSDD treatment and to perform a meta-analysis to synthesize the trial results to determine if bupropion is effective