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Amitriptyline for Premature Ejaculation: Does It Work?

Antidepressants are commonly used off-label to treat premature ejaculation (PE). Amitriptyline for premature ejaculation is also used but does it work? Should you use amitriptyline for premature ejaculation? And if you are prescribed amitriptyline for anxiety or depression, what to expect?

Amitriptyline delays ejaculation as a side effect and might lead to other sexual issues. Yes, it does delay ejaculation, but it isn’t a medicine you should use for premature ejaculation.

This article uncovers everything about amitriptyline and premature ejaculation, its side effects, does it delay ejaculation, how it affects sperm health, and what other medicines you should use for premature ejaculation.

What is Amitriptyline?

Amitriptyline (also known as Elavil) is a tricyclic antidepressant that is used to treat depression and anxiety. It is also used to treat pain such as migraine attacks. Amitriptyline is a prescription drug and is available in both tablet and syrup form.

The Elavil works by increasing the amount of serotonin (neurotransmitter) which improves mood and your body’s reaction to pain. When your body produces more serotonin, you start feeling better and the pain intensity is reduced significantly.

The Elavil tablets and syrup are available in 10 mg, 25 mg, and 50 mg strengths. The maximum recommended dosage per day is 75 mg.

Amitriptyline Uses

Here are the primary uses of Elavil:

  • It is used primarily as an antidepressant
  • Back pain treatment
  • Migraine attacks
  • Arthritis
  • Fibromyalgia (chronic pain throughout the body)
  • Improve mood
  • Boost energy level and sleep better.

Amitriptyline Side Effects

Amitriptyline has several common and serious side effects as discussed below:

  • Constipation
  • Dizziness and drowsiness
  • Blurred vision
  • Dry mouth
  • Headache
  • Issues in peeing
  • Heartburn
  • Heartbeat fluctuation
  • Suicidal thoughts
  • Eyesight issues
  • Stomach pain
  • Seizures
  • Fever
  • Confusion
  • Sweating
  • Muscle stiffness
  • Difficulty reaching orgasm
  • Reduction in sexual desire.

Does Amitriptyline Work for Premature Ejaculation?

Yes, amitriptyline works for premature ejaculation.

A serious side effect of amitriptyline is that it causes sexual dysfunction which includes a reduction in sexual desire and drive, delayed orgasm, and erection issues.

A systematic review analyzed the impact of Elavil on sexual dysfunction and found that amitriptyline causes sexual dysfunction in men which includes premature ejaculation. Men who use amitriptyline are 6x more likely to suffer from sexual dysfunction as compared to women and this is more common in depressive male patients. Further analysis revealed that amitriptyline has a significant and higher impact on libido and arousal as compared to orgasm and ejaculation.

This shows that men who use amitriptyline might have libido, arousal, orgasm, and ejaculation issues. And they are more likely to have delayed ejaculation.

If you are taking Elavil, you might suffer from low sex drive and arousal, poor erection, problems maintaining an erection, and delayed orgasm. Consistent use of amitriptyline doesn’t cause premature ejaculation, you will start feeling better (and would recover) after stopping the medicine.

Does Amitriptyline Delay Ejaculation?

Amitriptyline for premature ejaculation

Yes, amitriptyline delays ejaculation.

A side effect of amitriptyline, like any other tricyclic antidepressant, is that it negatively impacts sexual performance and activity in both men and women. A delay in orgasm is a commonly known side effect of amitriptyline.

Antidepressants like amitriptyline prevent cells from reabsorbing serotonin (a neurotransmitter that plays a major role in ejaculation). When serotonin fails to be absorbed by the cells, it delays the ejaculation process because serotonin needs to be reabsorbed by the cells to function properly and ejaculate in time.

A 2015 study on rats revealed that injecting serotonin in the brain leads to delayed ejaculation in rats. And since antidepressants work by delaying the reabsorption of serotonin in the cells, it mostly delays orgasm in both men and women.

Does Amitriptyline Reduce Testosterone?

Does Amitriptyline Reduce Testosterone

Yes, consistent use of amitriptyline reduces testosterone levels.

A study reported that taking 10 mg of amitriptyline twice a day for 21 consecutive days reduces testosterone levels. A 2021 review study analyzed the impact of antidepressants on testosterone and found several clinical and preclinical studies that cited a reduction in testosterone levels. Another study found similar results that amitriptyline impacts sex hormones including testosterone. Higher doses (25 mg per kg) are more likely to reduce testosterone levels with low doses having less severe effects.

A 2023 study endorsed these results that taking amitriptyline in high dosage reduces testosterone levels significantly.

Amitriptyline is more likely to reduce testosterone when taken in a high dosage. However, low dosage might not have too severe an impact on testosterone levels.

Can Amitriptyline Affect Sperm?

Can Amitriptyline Affect Sperm?

Yes, amitriptyline negatively affects sperm health.

Antidepressants are known to negatively impact sperm in healthy men. A study analyzed the impact of antidepressants in mice and found that mice who were given amitriptyline had weak sperm parameters likely due to the toxicity of amitriptyline.

A 2018 study on male rats found similar results. Rats were given amitriptyline which decreased sperm count, increased sperm abnormalities, and significantly decreased hormone parameters. A 2019 review analyzed the impact of antidepressants on semen and male fertility. The study concluded that antidepressants negatively impact sperm health with a reduction in sperm concentration and motility and a significant decrease in the weight of reproductive organs such as testicles.

Amitriptyline, like any other antidepressant, negatively impacts sperm health and might lead to temporary infertility. Once you stop taking Elavil, your sperm health will get back to normal after some time (not immediately).

Should You Use Amitriptyline to Last Longer in Bed?

No, you should not use amitriptyline to treat premature ejaculation.

This drug isn’t meant to be used for PE. It is a prescription medicine, your doctor will suggest this to you based on your medical condition which doesn’t include premature ejaculation.

Doctors, normally, prescribe selective serotonin reuptake inhibitors (SSRIs) for premature ejaculation which is a different class of antidepressant drugs. SSRIs have fewer side effects and do not severely affect heart functioning. Tricyclic which is the class of antidepressant drugs that have a major impact on the heart and have more serious side effects aren’t used for premature ejaculation. Tricyclic antidepressants (TCAs) are used when other types of antidepressants don’t work on a patient. Since amitriptyline is a TCA, it has serious side effects, and it isn’t used for the treatment of premature ejaculation.

Even if you get a chance to use amitriptyline or Elavil for delaying orgasm, do not use it.

What Medication is Best for Premature Ejaculation?

There is no FDA approved drug for premature ejaculation. You can either use an off-label prescription medicine (SSRI) or you can use non-prescription medicines which are mostly herbal supplements.

1. Off-Label Drugs

The unapproved use of an approved drug is known as off-label. Since the FDA hasn’t approved any medicine for premature ejaculation, doctors prescribe SSRIs which are antidepressants with fewer side effects to treat PE. This is an off-label use of antidepressants which isn’t recommended by the FDA.

Here is a list of the common antidepressants used for PE:

  1. Paroxetine
  2. Sertraline
  3. Fluoxetine
  4. Escitalopram
  5. Citalopram.

These are antidepressants which are SSRIs. They have relatively fewer side effects than tricyclic antidepressants so your doctor might prescribe you one of these medicines for PE. All these antidepressants have a common side effect that they delay orgasm and might cause sexual dysfunction.

Do not use an antidepressant without consulting your physician.

2. Non-Prescription Medicines

Not all men like taking antidepressants for premature ejaculation primarily due to serious side effects. If you are trying to conceive, using an antidepressant might be suicidal as it negatively impacts sperm and significantly reduces the chances of getting your partner pregnant.

Over the counter herbal pills seem to be a nice option when using antidepressants sounds too scary. You can buy herbal tablets without a prescription to treat premature ejaculation. These aren’t as effective as antidepressants and might not deliver instant results, but OTC pills are safe with minimal side effects.

Some of the non-prescription drugs for premature ejaculation are backed by clinical tests. ProSolution Plus, for example, is a non-prescription herbal tablet for PE that is scientifically tested to increase ejaculation duration in men by 64% when used consecutively (one tablet a day).

A study reported that 148 healthy men who used ProSolution Plus for 60 days improved ejaculation duration by 64% and 78% improvement in overall sexual satisfaction.

These types of herbal tablets give you a better chance of overcoming premature ejaculation.

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Which Antidepressant Works Best for Premature Ejaculation?

Antidepressants belonging to the selective serotonin reuptake inhibitor (SSRI) drug class usually work best for PE due to minimal side effects. Popular SSRI antidepressants include paroxetine, sertraline fluoxetine, escitalopram, and citalopram. Scientifically, paroxetine works best for premature ejaculation patients as it delivers the best results quickly with minimal side effects.

Why Do Antidepressants Make You Last Longer in Bed?

Antidepressants make you last longer in bed because all antidepressants have a side effect that they delay orgasm. Antidepressants work by reducing the reabsorption of the neurotransmitter serotonin in your cells. The delay in reabsorption of serotonin in body cells delays ejaculation because your cells need to reabsorb serotonin to orgasm. Antidepressants delay serotonin reabsorption (reuptake) in cells.

Do Antidepressants Prolong Ejaculation?

Yes, antidepressants of all drug classes prolong ejaculation. Antidepressants have a side effect that they delay ejaculation since antidepressants increase the production of serotonin in your brain. Increased production of serotonin improves your mood and makes you happy and at the same time, antidepressants block the reabsorption of serotonin in cells. This makes serotonin available in your body for a longer period. Serotonin is also responsible for ejaculation, so a high production means you take longer to ejaculate.

Can I Take Viagra with Amitriptyline?

Yes, you can take Viagra with amitriptyline. A study analyzed the impact of Viagra on amitriptyline and reported that sildenafil does not affect amitriptyline rather it can enhance the impact of antidepressants including amitriptyline. However, you can take them if your doctor has prescribed you both medicines. These are prescription medicines and shouldn’t be used without a valid prescription.

Final Thoughts

Amitriptyline for premature ejaculation isn’t a suitable option. It is an antidepressant and not a prescription medicine to cure PE. It has multiple side effects including some serious side effects and this is a reason why amitriptyline isn’t the first antidepressant that doctors use. It is only prescribed when other antidepressants do not work.

If you want to treat premature ejaculation, there are other better medicines that you should use. Amitriptyline isn’t the right drug for it.

You should consider using SSRI antidepressants which have fewer side effects. Or you can use a non-prescription herbal medicine like ProSolution Plus which has no side effects and is scientifically proven to treat premature ejaculation.

Updated: August 29, 2023