The drugs can delay premature ejaculation
PE occurs when a man always (or nearly always) experiences ejaculation within a minute or less during sexual activity. It can also be defined as the inability to regularly delay ejaculation and reacting with distress or avoidance of sexual intimacy. Premature ejaculation may be "lifelong," beginning when the man first becomes sexually active and occurring with nearly every partner. Or it may be "acquired," occurring after having normal ejaculation times up until then.
Traditionally, the only options for men with PE were psychotherapy and behavioral therapy. But some men explore medical options, including low doses of the antidepressants known as selective serotonin reuptake inhibitors (SSRIs). These drugs are FDA-approved for the treatment of depression, and some are approved for other health conditions. But others have increasingly become first-choice drugs—although used "off-label" for PE—which may be related, in part, to lower levels of serotonin, a chemical in the brain that has a delaying effect in ejaculation. SSRIs increase the production of serotonin, and a side effect, first noted in the treatment of depression, is prolonging the time it takes to reach ejaculation. (Doctors can legally prescribe any medication for conditions other than those approved by the FDA.)
"Most men with premature ejaculation respond to daily treatment with SSRIs, and some respond really well," says Ira Sharlip, M.D., a clinical professor of urology at the University of California, San Francisco, and a spokesman for the American Urological Association. "But there are significant side effects that, while not harmful, are unpleasant for the patients who experience them."
Suicidal behavior. A black-box warning—the FDA's most serious label alert—states that SSRIs have been reported to increase the risk of suicidal thinking and behavior in children, adolescents, and young adults with major depression and other psychiatric disorders. The incidence of suicide is lower among those older than 25 with major depression. But no matter what your age, if you're thinking about hurting yourself, talk with your doctor.
Serotonin syndrome
This life-threatening reaction is rare but happens most often when two serotonin-boosting drugs are used at the same time, causing agitation, coma, changes in heart rate and blood pressure, hallucinations, loss of coordination, and vomiting. Avoid the use of older antidepressants such as monoamine oxidase inhibitors, triptan medications for migraine headaches such as almotriptan (Axert) and tramadol (Ultram), and tryptophan supplements. Some other drugs that raise serotonin levels include:
- St. John's wort and other herbal products
- Over-the-counter medicine that contains dextromethorphan, used for coughs
- Prescription pain medications, like meperidine (Demerol and generic)
Withdrawal effects. SSRIs shouldn't be stopped suddenly because that can cause such symptoms as agitation, anxiety, dizziness, insomnia, nausea, nightmares, shock-like sensations, and tremors.
Sexual side effects. Decreased desire and problems reaching orgasm might occur with SSRIs, but those side effects are reported less frequently in men taking the drugs for PE. Talk with your physician about diminished libido or other sexual problems that appear during treatment.
Low sodium. People who take diuretics might be at the greatest risk for this problem. Symptoms include confusion, headaches, memory and concentration impairment, unsteadiness, and weakness.
Weight gain. This might increase the risk of diabetes.
Abnormal bleeding. The risk is uncommon but higher in people taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Advil).
Prolonged erection. If this rare but serious reaction occurs, discontinue using the drug and call your doctor.
Sexual side effects. Decreased desire and problems reaching orgasm might occur with SSRIs, but those side effects are reported less frequently in men taking the drugs for PE. Talk with your physician about diminished libido or other sexual problems that appear during treatment.
Low sodium. People who take diuretics might be at the greatest risk for this problem. Symptoms include confusion, headaches, memory and concentration impairment, unsteadiness, and weakness.
Weight gain. This might increase the risk of diabetes.
Abnormal bleeding. The risk is uncommon but higher in people taking blood thinners or nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Advil).
Prolonged erection. If this rare but serious reaction occurs, discontinue using the drug and call your doctor.
What other measures can you try?
Rule out other conditions. Your doctor should ask about your medical and sexual history before prescribing a drug for PE. A physical exam might be necessary in the initial assessment of the condition, which is occasionally caused by inflammation of the prostate or an overactive thyroid. The underlying condition should be treated first.
Consider a topical anesthetic. It can be an effective alternative treatment for PE. Lidocaine-prilocaine cream (Emla) is applied to the penis 20 to 30 minutes before intercourse. A condom should be worn to avoid transferring the product to a partner.
Use a condom. It might reduce stimulation and thus delay ejaculation for some men.
Try relationship counseling and behavioral approaches. This includes the stop-and-start technique, the squeeze method, and thought distraction. These can be used on their own or in combination with drug treatment.
Bottom line. Studies have found that daily treatment with certain SSRIs, especially paroxetine, can delay ejaculation for men with PE. An on-demand regimen has been found to be less effective but can pose fewer side effects. Our advice: Talk with your doctor about all available drug and nondrug treatments for PE, and consider SSRIs only after the risks and benefits have been thoroughly explained to you.
Consider a topical anesthetic. It can be an effective alternative treatment for PE. Lidocaine-prilocaine cream (Emla) is applied to the penis 20 to 30 minutes before intercourse. A condom should be worn to avoid transferring the product to a partner.
Use a condom. It might reduce stimulation and thus delay ejaculation for some men.
Try relationship counseling and behavioral approaches. This includes the stop-and-start technique, the squeeze method, and thought distraction. These can be used on their own or in combination with drug treatment.
Bottom line. Studies have found that daily treatment with certain SSRIs, especially paroxetine, can delay ejaculation for men with PE. An on-demand regimen has been found to be less effective but can pose fewer side effects. Our advice: Talk with your doctor about all available drug and nondrug treatments for PE, and consider SSRIs only after the risks and benefits have been thoroughly explained to you.
The drugs can delay premature ejaculation
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