Painful ejaculation and urinary hesitancy in association with antidepressant therapy: relief with tamsulosin.
Painful ejaculation has been reported in association with a variety of antidepressants such as the tricyclic antidepressants (TCAs, e.g. clomipramine, imipramine, desipramine, protriptyline, amoxapine), the selective serotonin reuptake inhibitors (SSRIs, e.g. fluoxetine), venlafaxine and the MAOIs. Apart from lowering the dose and changing the antidepressant, no strategies are available to treat this side effect. In this paper, painful ejaculation following the administration of reboxetine is described in two patients. Both patients were treated concomitantly with the selective alpha(1A)-adrenoceptor antagonist, tamsulosin. A re-challenge was performed in one patient. The Hamilton Depression Rating Scale (HAM-D), the American Urological Association symptom index, a (dis)satisfaction item score and the Udvalg for Kliniske Undersoegelser (UKU-side effect rating scale) were used to assess the treatment. Tamsulosin rapidly and completely resolved the painful ejaculation and urinary hesitancy in both patients. A re-challenge in one patient resulted in a prompt reappearance of both side effects. Tamsulosin resolved the problem of painful ejaculation in these patients; however, larger studies are needed to confirm these results.
University Hospitals Gasthuisberg, Department of Psychiatry and Institute for Family and Sexological Sciences, Herestraat 49, 3000 Leuven, Belgium. keon.demyttenaere@med.kuleuven.ac.be
Koen
K
Demyttenaere
Remko
R
Huygens
D000317:Adrenergic alpha-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects*; D004542:Ejaculation / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009025:Morpholines / Q000009:adverse effects; D010146:Pain / Q000139:chemically induced / Q000188:drug therapy; D000077593:Reboxetine; D013449:Sulfonamides / Q000627:therapeutic use*; D000077409:Tamsulosin; D014555:Urination Disorders / Q000139:chemically induced / Q000188:drug therapy*
D000317:Adrenergic alpha-Antagonists; D000928:Antidepressive Agents; D009025:Morpholines; D013449:Sulfonamides; D000077593:Reboxetine; D000077409:Tamsulosin