"Reply to Weight Gain, Sexual Dysfunction and Buropion."

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Sir: Our recent article¹ examining the factors influencingpsychiatrists’ prescription of bupropion was based on 3 propositions:(1) all antidepressant medications are generally equallyeffective2; (2) weight gain and sexual dysfunction are the 2 sideeffects that are of greatest concern to patients and have thegreatest impact on long-term compliance; and (3) bupropionis not associated with either weight gain or sexual dysfunction.Dr. Menaster questioned the accuracy of our third propositionand concluded that bupropion is associated with weight gainand sexual dysfunction. He cited 4 lines of evidence supportinghis conclusion: (1) case reports; (2) reports of weight gain in thepackage insert for bupropion extended-release (XL); (3) reportsfrom naturalistic, observational studies; and (4) the results of ameta-analysis comparing bupropion and selective serotoninreuptake inhibitors (SSRIs).’ ‹’ ‹