Sex and Antidepressants

Question
I have a patient who reported sexual side effects before with selective serotonin reuptake inhibitors (SSRIs). I started her on bupropion (Wellbutrin XL), but discontinued it because the patient could not tolerate headache for 2 weeks. I thought they would pass but they did not. Any suggestions about what I should do next?
Response from Michael E. Thase, MD Professor of Psychiatry, University of Pittsburgh Medical Center; Chief, Division of Adult Academic Psychiatry, Western Psychiatric Institute and Clinic, Pittsburgh, Pennsylvania
About 1 in 3 patients treated with SSRIs or serotonin-norepinephrine reuptake inhibitors (SNRIs) experience significant sexual dysfunction.[1] Because this side effect can sometimes lessen with the passage of time, a "wait-and-see" approach is often initially prudent. When the sexual side effect persists across a number of weeks, therapeutic action is generally necessary. Options include reducing the dose of the offending medication, adding a second medication with "antidote-like" effects, and switching to an alternate medication with a lower likelihood of sexual side effects.[2]
Let's assume in the case described that dose reduction of the SSRI was attempted and resulted in a decrease in symptomatic benefit and the treating clinician opted to switch to bupropion. This is normally the best choice with respect to reversal of the SSRI-induced sexual dysfunction (ie, bupropion has about the same risk of causing sexual side effects as an inert placebo).[3] However, bupropion, classified as a norepinephrine-dopamine reuptake inhibitor, is mechanistically unrelated to SSRIs and there are the possibilities of different side effect issues and/or lack of response. In this particular case, headache has emerged as an unacceptable side effect during bupropion therapy.