Utility of selective serotonin reuptake inhibitors in premature ejaculation.
The introduction of selective serotonin reuptake inhibitors (SSRIs) has revolutionized our understanding of the treatment of premature ejaculation. Lifelong premature ejaculation may be a neurobiological phenomenon, namely part of a biological variability of the intravaginal ejaculation latency time in men. Animal studies support this view, and an animal model for premature and delayed ejaculation has recently been developed. It is proposed that drug treatment of premature ejaculation should consist of 5-hydroxytryptamine (5-HT)2c receptor stimulation and/or 5-HT1A receptor inhibition. A meta-analysis of 35 daily treatment studies with selective serotonin reuptake inhibitors (SSRIs) and clomipramine demonstrated comparable efficacy of clomipramine with the SSRIs sertraline and fluoxetine in delaying ejaculation, whereas the efficacy of the SSRI paroxetine was greater than all other SSRIs and clomipramine. It is postulated that acute treatment with SSRIs, including those with short half-lives, will not produce an ejaculation delay equivalent to that induced by daily treatment of SSRIs.
Department of Psychiatry and Neurosexology, Leyenburg Hospital, 2545 CH The Hague, The Netherlands. md@waldinger.demon.nl
Marcel D
MD
Waldinger
Berend
B
Olivier
D000818:Animals; D004195:Disease Models, Animal; D004334:Drug Administration Schedule; D004542:Ejaculation / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D008297:Male; D015201:Meta-Analysis as Topic; D044282:Receptor, Serotonin, 5-HT1A / Q000627:therapeutic use; D044405:Receptor, Serotonin, 5-HT2C / Q000627:therapeutic use; D058829:Serotonin 5-HT1 Receptor Antagonists; D058826:Serotonin 5-HT2 Receptor Agonists; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D012735:Sexual Dysfunction, Physiological / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D020018:Sexual Dysfunctions, Psychological / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D044282:Receptor, Serotonin, 5-HT1A; D044405:Receptor, Serotonin, 5-HT2C; D058829:Serotonin 5-HT1 Receptor Antagonists; D058826:Serotonin 5-HT2 Receptor Agonists; D017367:Selective Serotonin Reuptake Inhibitors