Dr. Ashton and Colleagues Reply

To the Editor: We appreciate the opportunity to respond to comments submitted by Dr. Hierholzer. We, too, found it disappointing to be unable to show the statistical superiority of 3 weeks of sustained-release bupropion, 150 mg/day at 6 p.m., over placebo for the treatment of SSRI-induced sexual dysfunction. We are glad to report that since our letter was submitted, two other studies have given us optimism that sustained-release bupropion may be a useful antidote when managing SSRI-related sexual dysfunction. DeBattista et al. (1) presented new research at the 2001 annual meeting of the American Psychiatric Association showing statistically significant improvement in sexual arousal in 42 patients with SSRI-induced sexual dysfunction who were taking sustained-release bupropion, 150 mg/day, for 6 weeks. In addition, Clayton et al. (2) presented new research at the same meeting showing the statistical superiority of 4 weeks of treatment with sustained-release bupropion, 150 mg b.i.d., over placebo in enhancing sexual desire and increasing the frequency of sex, which was used as a measure of greater sexual satisfaction. A total of 42 patients, mostly women, were enrolled in this study.

Finally, we were pleased as researchers and clinicians not to have felt limited by GlaxoSmithKline when trying to publish our data. In fact, to its credit, GlaxoSmithKline welcomed dissemination of this information to allow clinicians to get a sense of dosing parameters for sustained-released bupropion and, subsequently, to maximize response. Now that further studies are coming out, we can infer that our dose and duration may have been insufficient to reverse the sexual side effects in some patients and that longer treatment durations or higher doses may be helpful. Our study let physicians understand that underdosing or using too brief a trial may not lead to an optimal response in some patients. This information would not have been widely disseminated had GlaxoSmithKline pressured us not to publish this negative study. We encourage other pharmaceutical companies and journals to allow publication of negative studies for precisely these reasons.