NOVEMBER 15, 2004
VOLUME 1 NO. 21
 

Off-label SSRI use for premature ejaculation
gains momentum

The quest to conquer the other male sexual dysfunction


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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