THE HAPPY, SEXY, SKINNY PILL?
IWellbutrin, an antidepressant that can spur weight loss and boost libido, is on everyone’s lips.
Sari Botton reveals why she’s on auto-refill.
was 47 when I went to my doctor seeking an antidepressant but with two firm deal breakers: I wouldn’t take any drug that would make me gain weight or one that would make sex more problematic than it had already become. Four years prior I’d had a partial hysterectomy. And while I’d insisted on retaining my ovaries so I could go through “the changes” more gradually, two months post-op, the hot flashes began. On the heels of those came mood swings and depression, followed by dryness and pain during sex, which naturally made me want to do it less often.
My doctor prescribed 150 milligrams of Wellbutrin, or bupropion, twice a day, and a month later I had the libido of an 18-year-old boy. Everything changed – no more dryness, no more pain. An increased interest in sex. Not to mention that my mood was elevated and I was generally more upbeat. And not only haven’t I encountered the weight gain people often complain of with selective serotonin reuptake inhibitors (SSRIs) like Prozac but my metabolism got a boost. Nothing dramatic; I just got a little trimmer without changing my diet or exercising more, though it isn’t clear whether or how Wellbutrin affects metabolism. In fact, GlaxoSmithKline, its manufacturer, settled with the US government in 2012 over allegations that it had previously encouraged its reps – among them TV doc Drew Pinsky – to promote the drug as the “happy, horny, skinny pill”, although its uses in treating sexual dysfunction and managing weight are off-label. “It works on norepinephrine,” says Elissa Gretz Friedman, assistant professor of obstetrics, gynaecology, and reproductive science at the Icahn School of Medicine at New York’s Mount Sinai, “so it might be that it reduces appetite.”
It turns out that the problems I was having are not terribly unusual for women in their 40s. “It’s not simply women in their 60s who have these issues,” notes Friedman. “Menopausal symptoms like sexual dysfunction commonly start in perimenopause, which can be five or so years prior to menopause,” which begins, on average, at 51. Lucy Puryear, a psychiatrist and a co-director of the Menopause Center at Texas Children’s Pavilion for Women in Houston, pegs it to an even earlier stage of life. “Testosterone levels in women start declining as early as the 30s,” she reveals. “And that can certainly have an effect on sex drive.” In women, physical factors can contribute to decreasing libido. But as your body ages, there are social changes that can affect your mood and your selfesteem, too.” So for many women, it’s hard to know which came first – a downturn in mood or in sexual interest.
It’s not entirely clear to me whether my own issues were the result of depression, or the cause of it, or just concurrent with it. What I do know is that the Wellbutrin helped. “It’s definitely the antidepressant that we know does not have adverse sexual side effects,” Friedman says. “It works in a different way than common SSRIs. It increases norepinephrine and dopamine,” which are involved in female sexual response. She adds that smaller dosages of Wellbutrin are often prescribed for women who are already taking SSRIs, to offset negative sexual side effects. “There have been many studies that have looked at sexual function and bupropion, including ones that looked at women who had not been depressed but did seem to decrease over time.” Rachel Hess, an associate professor of medicine at the University of Pittsburgh, cautions against seeing Wellbutrin as a onesize-fits-all antidepressant and sexual aid. “For many, Wellbutrin is an excellent drug like Viagra, shortly before sex.” But, Hess adds, “there can be problems with using Wellbutrin that are non-trivial: it can exacerbate eating disorders and anxiety disorders, and it can make some people prone to seizures.”
Fortunately, I don’t have any of those issues. I couldn’t wait to tell my gynaecologist, Christine Herde, who practises in Poughkeepsie, New York, that Wellbutrin had turned this peri-menopausal forty-something into a veritable porn star. She applauded my decision to get a prescription. “You recognised that you needed help,” she says, “and you were willing to take medication, which many women aren’t. This lets you have an active sex life, and that keeps things working. The more activity you have, the more pliable the vaginal tissue remains. This is very important.” That’s right – you heard the doctor: use it or lose it.