There are classic remedies for
men who are, well, a little quick on the trigger. Some
men think about baseball; others lie back and think of
the Queen. The latest remedy for the ancient riddle of
premature ejaculation (PE) is prescribing selective serotonin
reuptake inhibitors (SSRIs). So are antidepressants the
new baseball stats?
OFF-LABEL
BONANZA
Dr Gerald Brock, chair of the Canadian Male Sexual Health
Council, and a urologist and associate professor of
medicine at St Joseph's Health Centre in London, ON,
says prescribing antidepressants for PE is becoming
common in Canada. "Because there are no approved specific
therapies for PE," he says, "many SSRIs like sertraline
and paroxetine are being prescribed, along with some
non-SSRIs like clomipramine."
The double-edged sword of PE is
that, on the one hand doctors don't always adequately
treat the condition, and on the other, patients are
often reluctant to seek treatment out of embarrassment,
according to Dr Brock. "It's basically where we were
with erectile dysfunction 10 years ago," he says, referring
to the pre-sildenafil dark ages. But are prescription
drugs really the best kind of foreplay in this case?
SIDE
EFFECT CONCERNS
"They are effective" says Dr Brock, but notes there
are some concerns about using non-indicated drugs like
SSRIs. "They have long half-lives, they're not designed
to treat PE, and they can cause nausea, fatigue and
malaise in patients." The delayed ejaculation experienced
by patients on SSRIs is but one of many (potentially
harmful) side effects; the drugs can also cause ejaculation
failure and impotence. An article in last December's
Annals of Pharmacotherapy found that citalopram
withdrawal can actually cause PE.
Drug treatment should only be a
part of the picture, says Dr Brock. "Because PE is such
an important medical condition, a three-pronged attack
is needed to be effective," he says. "Education of physicians
and patients, so men don't avoid treatment; recognition
that there are treatments such as psychological and
sexual therapy, combined with medical therapy, SSRI
prescription with psychological therapy; and the development
of new agents are what's required."
THE
EVIDENCE
A recent review article out of the Netherlands, in the
July issue of Current Opinion in Investigational
Drugs, calls for increased use of the therapy, saying
that its overview found that paroxetine showed the greatest
efficacy, and that daily intake appears to yield better
ejaculation delay than acute treatment. The same team
conducted a randomized controlled trial in 1998, published
in the Journal of Clinical Psychopharmacology,
that concluded that ejaculation delay went from 60 seconds
or less to 110 seconds in men treated with paroxetine,
fluoxetine, and sertraline. While the pharmaceutical
industry is working overtime to produce a new drug that
will delay ejaculation without any side effects, nothing
has yet been approved.
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