Individualized antidepressant therapy in patients with major depressive disorder

We are writing to alert authors and readers that claims regarding the efficacy of bupropion as a treatment for sexual dysfunction as reported within the Individualized Antidepressant Support Tool (Chin et al Can Fam Phys Nov 2022) do not appear to be based on reliable evidence. Figure 1A within the tool suggests that bupropion is incredulously efficacious for “loss of libido in women” with an “NNT=2”. The reference for this claim is a single trial by MR Safarinejad (PMID: 20151970), an author who has had several publications retracted (Retraction Watch, PubMed), including a retracted trial of bupropion for male sexual dysfunction (PMID: 20067456). We were not able to confidently verify the results transposed into Figure 1A from the trial of bupropion in women. Figure 1B further suggests that bupropion may improve SSRI-induced dysfunction and reports a meta-analysis summary statistic “SMD 1.60”. The correct reference for this is a Cochrane Systematic Review (PMID: 23728643) where two trials from the same author (MR Safarinejad) contribute most of the data to the meta-analysis, including the aforementioned retracted trial. We were first alerted to these concerns by UpToDate which is cited by Chin et al as one of the references they used to inform the Individualized Antidepressant Support Tool.