What is the recommended replacement medication for fluoxetine in a patient experiencing sexual dysfunction?

In the context of managing sexual dysfunction induced by fluoxetine, bupropion is generally considered a well-suited alternative. This is primarily because bupropion has a different mechanism of action than selective serotonin reuptake inhibitors (SSRIs) like fluoxetine, which can often cause or exacerbate sexual side effects such as decreased libido, delayed orgasm, or erectile dysfunction.

Bupropion is a norepinephrine-dopamine reuptake inhibitor (NDRI) and is known for having a more favorable sexual side effect profile compared to SSRIs. It is also used to treat major depressive disorder and seasonal affective disorder and has been indicated for smoking cessation as well. The unique action of bupropion on dopamine and norepinephrine can enhance sexual functioning and may improve symptoms of sexual dysfunction that some individuals experience with SSRIs.

While sertraline and citalopram are also SSRIs, they may not address the sexual side effects as effectively as bupropion does, since they can share similar side effect profiles with fluoxetine. Amitriptyline, being a tricyclic antidepressant, can also cause sexual side effects and is not a first-line treatment for depression due to its side effect burden. Thus