SSRI (Selective serotonin reuptake inhibitors) is a type of antidepressant traditionally used to treat anxiety and depressive disorders. Since some patients using SSRIs complained of a delay in ejaculation, some researchers in the early 90s developed an interest for its potential as a treatment for premature ejaculation. Nowadays, doctors can prescribe SSRIs as an off-label treatment for premature ejaculation in some countries. There is even a telemedicine service in the USA that can prescribe on-demand sertraline for treating premature ejaculation. Based on actual data, it’s the best premature ejaculation drug to delay ejaculation.
A Word of Caution
Before we start, we just want to be crystal clear about one thing. All the drugs listed here are strong medicine and available only via a doctor’s prescription. Never use a prescription drug for which you do not have a prescription. Your health is not something you want to risk, and taking medication without a professional medical advice poses serious health risks.
If you consider using drug treatment for premature ejaculation, please consult a physician first and respect his instructions. This page’s goal is only to present the options available, but it isn’t a professional medical opinion. I’m not aware of every counter indication those drugs may have, neither your particular health condition. Your doctor is, that’s why he’s the one you should trust.
If you are looking for an over-the-counter product to treat premature ejaculation, delay creams, sprays or condoms could be effective solutions.
How SSRI Works
SSRI stands for serotonin-specific reuptake inhibitors. Also called serotonergic antidepressants, it’s a class of drug that increases the serotonin level. Serotonin is a neurotransmitter. Neurotransmitters are the messengers of your nervous system. You can read more about how it works here.
The way in which SSRI delay ejaculation is complicated and not entirely understood. A diminished serotonin level is one of the believed cause of premature ejaculation. Scientists suspect that serotonin plays a role in ejaculation inhibition. Without a functioning serotonin level, your body triggers the ejaculation reflex too soon. SSRIs reduce the natural capacity of your synapses to recapture the serotonin that it releases. So, taking an SSRI increase your serotonin level. Thereby, it also delays ejaculation.
There are different types of SSRI. Paroxetine, sertraline, fluoxetine, citalopram, and fluvoxamine are the most common type of SSRI. While most of them delay ejaculation, they aren’t all as effective. Paroxetine is the most effective of all.1
About Efficacy Measure
A premature ejaculation drug’s efficacity is measured with a unit called ITEL fold increase. You can read more about how different treatment are compared together here. In short, IELT stands for Intravaginal Ejaculation Latency Time. It’s a stopwatch measure of the intercourse time, from the start of the penetration to the ejaculation. We calculate a couple average IELT by timing all their sexual relations on a specified period.
The fold increase is calculated like this: ((IETL after / IETL before) – IETL before). For example, let’s take a couple that has a 1 min average IELT that increases to 2 min after treatment. It represents a 1-fold increase: (2/1) – 1 = 1. If it increases to 3 min, it’s a 2-fold increase: (3/1) – 1 = 2.
The Most Effective SSRI for Premature Ejaculation
Paroxetine, sertraline, fluoxetine, citalopram, and fluvoxamine are the most common type of SSRI. While most of them delay ejaculation, they aren’t all as effective. Paroxetine is the most effective one with a mean IELT fold increase of 8.8 for a dose that ranges from 10 to 40mg per day1. Fluvoxamine is the only SSRI that doesn’t seem to delay ejaculation2.
The drug efficacy continues as long as the user take it, but sometimes the delay effect can diminish after a couple of month1. Also, based on the clinical experience of an expert, some men (around 20%) do not experience any ejaculation delaying effect from SSRIs3.
You can find here a table that summarizes the mean IELT fold increase for several SSRI type1-4.
|SSRI Type||Dose||IELT Increase|
|Fluvoxamine||Do not have any ejaculation delay effect|
|Dapoxetine||30-60 mg/1-3h before sex||2.5-3.0|
Source: Treatment of Premature Ejaculation with Dapoxetine (2013) McMahon Chras G.. Chapter 20 in Premature Ejaculation, from Etiology from diagnosis and treatment, Jannini, Emmanuele, McMahon, Chris G., Waldinger, Marcel D., Springer-Verlag Mailand, 2013 p.256, ISBN 978-88-470-2646-9.
SSRI Usage for Premature Ejaculation
There is two type of drug usage for premature ejaculation: daily and on-demand. On-demand usage drugs are pills that you need to take 2 hours before having sex. Daily usage drugs are pills that you take each day for a prolonged effect.
Most SSRIs (paroxetine, sertraline, and fluoxetine) show a better efficacy with daily usage.
The way we understand how SSRI works, on-demand use of SSRIs isn’t as effective as daily usage. Indeed, animal studies don’t show any significant improvement in ejaculation latency from on-demand SSRI usage10. However, a specific short-term action SSRI has been specially developed to treat premature ejaculation. It’s called Dapoxetine. If you want more information on an on-demand drug for PE, you can read here our dapoxetine for premature ejaculation review. Note that even if SSRIs are more effective when they are taken daily, there is still a possibility to take some SSRI on-demand. For example, it’s the case with him’s, a telemedicine service that prescribe on-demand sertraline for men who suffer from premature ejaculation.
SSRI Side Effect
All SSRIs have potential side effects, including weight gain6 and an increased risk of bleeding.7 More serious side effects, albeit very rare, (for example, priapism8) can also occur. Still, specialists note that these side effects are generally mild and disappear after a couple of weeks4.
Please note that this isn’t a complete list of all SSRIs potential side effects. For a full list of all known side effects, please consult a health professional, like a doctor or a pharmacist.
SSRI Discontinuation Syndrome
It’s also important to note that SSRIs could lead to discontinuation syndromes if you stop taking the drug. Therefore, it’s better to stop taking the medication gradually. Tremor, shock-like sensations when turning the head, nausea and dizziness are potential discontinuation syndromes9. To avoid those, you need to talk to your doctor first if you want to stop the medication. He will lay out a withdrawal plan for you.
Wish for Pregnancy
Since we don’t know a lot about SSRIs effect on spermatozoid, some specialists suggest stopping SSRI usage gradually for men who are looking to father a child. Since the spermatozoa take some time to regenerate, it’s advised to use a condom for three months after the drug stoppage2.
- Waldinger MD, Zwinderman AH, Schweitzer DH, Olivier B (2004) Relevance of methodological design for the interpretation of efﬁcacy of drug treatment of premature ejaculation: a systematic review and meta-analysis. Int J Impotence Res 16:369–38, Althof SE, Abdo CHN, Dean J, Hackett G, McCabe M, McMahon CG, Rosen RC, Sadovsky R, Waldinger MD, Becher E, Broderick GA, Buvat J, Goldstein I, El-Meliegy AI, Giuliano F, Hellstrom WJG, Incrocci L, Jannini E, Park K, Parish S, Porst H, Rowland D, Segraves R, Sharlip I, Simonelli C, Tan HM (2010) International society for sexual medicine’s guidelines for the diagnosis and treatment of premature ejaculation. J Sex Med. 7:2947–2969
- Treatment of Premature Ejaculation with Selective Serotonin Re-Uptake Inhibitors (2013) Waldinger MD. Chapter 19 in Premature Ejaculation, from Etiology from diagnosis and treatment, Jannini, Emmanuele, McMahon, Chris G., Waldinger, Marcel D., Springer-Verlag Mailand, 2013 p.229-240, ISBN 978-88-470-2646-9.
- Waldinger MD, Hengeveld MW, Zwinderman AH, Olivier B (1998) Effect of SSRI antidepressants on ejaculation: a double-blind, randomized, placebo-controlled study with fluoxetine, fluvoxamine, paroxetine, and sertraline. J Clin Psychopharmacol 18:274–281, de Jong TR, Snaphaan LJ, Pattij T, Veening JG, Waldinger MD, Cools AR, Olivier B (2006) Effects of chronic treatment with fluvoxamine and paroxetine during adolescence on serotonin-related behavior in adult male rats. Eur Neuropsychopharmacol 16:39–48
- Pryor JL, Althof SE, Steidle C, Rosen RC, Hellstrom WJ, Shabsigh R et al (2006) Efficacy and tolerability of dapoxetine in treatment of premature ejaculation: an integrated analysis of two double-blind, randomised controlled trials. Lancet 368:929–937
- Waldinger MD (2007) Premature ejaculation: deﬁnition and drug treatment. Drugs 67:547–568
- Fava M, Judge R, Hoog SL, Nilsson ME, Koke SC (2000) Fluoxetine versus sertraline and paroxetine in major depressive disorder: changes in weight with long-term treatment. J Clin Psychiatry 61:863–86
- Weinrieb RM, Auriacombe M, Lynch KG, Lewis JD (2005) Selective serotonin re-uptake inhibitors and the risk of bleeding. Expert Opin Drug Saf 4:337–344
- Ahmad S (1995) Paroxetine-induced priapism. Arch Intern Med 155:645, Rand EH (1998) Priapism in a patient taking sertraline. J Clin Psychiatry 59:538
- Ditto KE (2003) SSRI discontinuation syndrome; awareness as an approach to prevention. Postgrade Med 114:79–84 , Black K, Shea C, Dursun S, Kutcher S (2000) Selective serotonin reuptake inhibitor discontinuation syndrome; proposed diagnostic criteria. J Psychiatry Neurosc 25:255–261
- Waldinger MD, Schweitzer DH, Olivier B (2005) On-demand SSRI treatment of premature ejaculation: pharmacodynamic limitations for relevant ejaculation delay and consequent solutions. J Sex Medicine 2:120–130
- Mos J, Mollet I, Tolboom JT, Waldinger MD, Olivier B (1999) A comparison of the effects of different serotonin reuptake blockers on sexual behaviour of the male rat. Eur Neuropsychopharmacol 9:123–135