Premature ejaculation (PE) is a common men’s global medical issue. Unfortunately, there is no prescription drug for PE and doctors have to use off-label drugs or topical desensitizing products. Selective serotonin reuptake inhibitor (SSRI) is an antidepressant that’s used off-label for the treatment of PE and is among the top prescription medicines globally.
This article explores SSRI and premature ejaculation, how effective SSRI is for PE, does it have side effects, what is the best SSRI for PE, its alternatives, and more.
Table of Contents
What is an SSRI?
Selective serotonin reuptake inhibitor (SSRI) is an antidepressant that’s used to treat symptoms of depression and anxiety. SSRIs have minimal side effects and this is a reason why these are the most common types of antidepressants used.
An SSRI works by increasing serotonin levels in your brain which is responsible for several functions including mood regulation, sleep, and sexual desire. Lack of serotonin in the human brain is linked with depression, mania, anxiety, and other health conditions. So, an SSRI increases serotonin levels in your brain, reduces its reabsorption (reuptake) in neurons, and selectively affects serotonin (and not any other neurotransmitters in your brain).
These benefits make SSRIs an ideal antidepressant.
Types of SSRI
The FDA has approved the following types of SSRIs for the treatment of depression:
- Fluoxetine
- Paroxetine
- Citalopram
- Sertraline
- Escitalopram.
SSRI Side Effects
SSRIs are generally safe and have minimal side effects. Most people don’t experience any side effects. The common side effects that some people experience are:
- Vomit and nausea
- Dizziness
- Sickness
- Diarrhea
- Headache
- Dry mouth
- Agitation and nervousness
- Loss of appetite and weight loss or weight gain
- Insomnia
- Blurred vision
- Sexual problems in men like loss of sex desire, loss of erection, difficulty reaching climax, and issues maintaining an erection.
Most of these side effects are avoidable. If one SSRI doesn’t work for you, another might be tolerable. Your doctor will know how and when to switch between SSRIs to minimize side effects.
SSRI and Premature Ejaculation
Selective serotonin reuptake inhibitors are used off-label for the management of premature ejaculation because SSRIs have a side effect that they delay orgasm. Men who are suffering from PE orgasm too quickly and struggle to last longer in bed. Since SSRI tends to delay climax in men, it is often prescribed by physicians to treat premature ejaculation.
The FDA has not approved any medicine for premature ejaculation. The options doctors are left with include therapies, exercises, lifestyle changes, and off-label drugs. An off-label drug is the use of a prescription drug for a purpose other than what it is approved by the FDA. It is the unapproved use of an approved drug. The purpose for which a medicine is used isn’t listed on its label so it’s termed as off-label. In this case, SSRIs are approved for the treatment of depression by the FDA and these are used off-label to treat premature ejaculation.
Off-label is very common and legal. There aren’t any issues in using a medicine as prescribed by an expert for a purpose not listed on its label.
And since SSRIs have minimal side effects, therefore, these are the best options available to doctors for the treatment and management of premature ejaculation.
Does SSRI Work for Premature Ejaculation?
Generally, antidepressants are quite effective in treating PE. Several studies analyzed the efficacy of different types of SSRIs and compared them with other climax control methods.
A review study analyzed 31 studies with a combined 8,254 participants who received 8 different types of SSRIs or placebo. The study concluded that SSRI treatment improves self-reported and self-perceived symptoms of PE significantly. It also improves satisfaction, self-perceived control over ejaculation, reduces distress, and improves IELT. SSRI treatment increases adverse effects in men but only a small percentage of participants withdraw due to side effects of SSRI. Overall, SSRI treatment is effective in treating and managing premature ejaculation irrespective of the SSRI type used.
A study examined the effect of fluoxetine, paroxetine, and escitalopram on premature ejaculation patients. Results revealed that all the 3 SSRIs improved ejaculation duration without any adverse effects. The 3 SSRIs are well-tolerated.
A study compared paroxetine and citalopram impact on ejaculation and found paroxetine more effective than citalopram. Paroxetine increased ejaculation duration from 18 seconds to 170 seconds while citalopram increased ejaculation timing from 21 seconds to 44 seconds. Paroxetine has a strong effect on delaying climax which is up to 9x.
Another comparative study examined the effect of 4 SSRIs (fluoxetine, paroxetine, sertraline, and fluvoxamine) on ejaculation. Paroxetine had the strongest effect followed by fluoxetine and sertraline while fluvoxamine had no impact on delay in ejaculation. Paroxetine increased ejaculation duration in lifelong PE patients by 480% which was the highest.
SSRIs positively impact ejaculation duration. However, not all SSRIs have an equal impact. Some of them perform better while others don’t do as well. Your doctor will decide what SSRI you need and when to change it.
Best SSRI for PE
Here’s a list of the SSRIs used for premature ejaculation:
- Paroxetine – Best SSRI for PE
- Fluoxetine
- Sertraline
- Citalopram
- Escitalopram.
1. Paroxetine: Best SSRI for PE
According to multiple clinical trials and scientific studies, paroxetine is the best SSRI for the management of premature ejaculation. It increases ejaculation duration much more than other SSRIs with minimal adverse effects.
Paroxetine is effective for lifelong PE and is ideal for long-term use. One study reported that using paroxetine for 6 weeks increased ejaculation duration by 11x and using it for 12 weeks increased ejaculation duration by 22x.
Studies that compared the effect of different SSRIs found paroxetine most effective. A study reported paroxetine to be better than citalopram as it increases ejaculation duration by 9x. Another study ranked paroxetine as the most effective and the best SSRI followed by fluoxetine and sertraline.
Another study compared the efficacy of dapoxetine and paroxetine and found paroxetine much more effective in delaying orgasm than dapoxetine. After 12 weeks of use, paroxetine increased climax duration from 31 seconds to 370 seconds while dapoxetine increased ejaculation timing from 38 seconds to 179 seconds.
Paroxetine is equally effective when taken regularly and on demand before sexual intercourse, according to this study. It is sold under the brand names Paxil and Seroxat and is best for premature ejaculation.
2. Fluoxetine
It is the second most effective SSRI for premature ejaculation. It is the parent drug of all the SSRIs and was approved by the FDA as an antidepressant back in 1987. It is a stronger SSRI and, therefore, its impact on delaying ejaculation is much stronger. But this comes with more adverse effects.
Doctors prescribe fluoxetine when other SSRIs don’t delay ejaculation. Long-term use of fluoxetine for PE isn’t recommended. A study reported that fluoxetine decreased PE from 98% to 41% and personal distress from 47% to 11%. However, continued use of fluoxetine beyond 6 months was reported to have a poor effect on PE. The participants in the study reported side effects including headache, dizziness, nausea, and sleepiness. So, while fluoxetine might be effective in treating premature ejaculation, long-term use isn’t recommended.
These results were endorsed by another study where PE patients used fluoxetine for the short term and found it to be effective in delaying orgasm. Side effects reported include nausea, headache, and insomnia.
Fluoxetine is often combined with other prescription drugs for the treatment of PE such as sildenafil and tadalafil. A study reported that the efficacy of fluoxetine increases when it is used with sildenafil on a needed basis before sexual intercourse. Another study found that using fluoxetine with tadalafil has the best impact on lifelong PE patients than using fluoxetine or tadalafil alone.
Fluoxetine is recommended to work best when taken 90 mg weekly on-demand, according to a study. It can be used alone for PE or in combination with tadalafil or sildenafil depending on your condition. Long-term use must be avoided.
Almost all the clinical trials reported a high degree of side effects which normally include headache, nausea, and insomnia. This is primarily because fluoxetine is stronger than other SSRIs.
3. Sertraline
Sertraline is an effective SSRI for PE that has been clinically tested in multiple studies. It can be used regularly and on-demand to delay climax during sexual intercourse.
One of the earliest studies reported that taking 25 mg sertraline per day increases ejaculation duration from 1 minute to 7.6 minutes and 50 mg per day increases timing from 1 minute to 13.1 minutes. Authors recommend taking 25-50 mg of sertraline per day for 2-3 weeks and then switching to on-demand (4-6 hours before sexual intercourse).
Other studies endorsed these findings where the effect of 50 mg sertraline is higher than 25 mg and long-term usage led to a significant increase in ejaculation timing. However, all the studies reported negative effects with major being dizziness, headache, anxiety, fatigue, and diarrhea. The side effects can be tackled by switching to on-demand after 2-4 weeks of regular use.
One study reported that sertraline improved premature ejaculation by 81% in 4 weeks. The PE condition was, however, worsened after 6 months of the experiment. This is a reason why on-demand sertraline works best for PE.
4. Citalopram
Citalopram, like other SSRIs, is effective in the treatment of premature ejaculation as it significantly increases intravaginal ejaculation latency time (IELT).
A study reported that men who used citalopram increased IELT from 32 seconds to 268 seconds over a period of 12 weeks. It also increased intercourse satisfaction. Another study reported an improvement of 69.3% in PE patients.
A comparison study analyzed citalopram and sertraline and found both of them equally effective for the treatment of premature ejaculation without any serious side effects in the participants. Another study compared the efficacy of citalopram and fluoxetine and found citalopram to be significantly effective in delaying orgasm in men with PE. Both SSRIs don’t have any impact on erection and sexual desire.
These studies confirm that citalopram is equally effective for delaying climax without any severe adverse effects.
5. Escitalopram
Escitalopram is an upgraded version of citalopram and is more effective. Studies have confirmed that 10 mg of escitalopram is equivalent to 40 mg of citalopram and it causes fewer side effects as it is 30x more potent than citalopram.
A meta-analysis compared the efficacy of escitalopram with other antidepressants and found escitalopram to be superior in terms of efficacy, acceptability, and tolerability to other SSRIs.
Escitalopram is also helpful in treating premature ejaculation. A study reported that daily use of escitalopram increases ejaculation duration in men suffering from PE. However, consistent daily use of escitalopram reduced sperm concentration, motility, and morphology. This is an unusual side effect that’s not reported with other SSRIs.
Escitalopram must be used with extreme caution for PE as regular use might negatively impact semen quality. Other SSRIs should be preferred.
SSRI for Premature Ejaculation Dosage
SSRIs are started with low doses per day regularly and it is gradually increased based on the response. Generally, 25 mg per day is considered the recommended SSRI dosage for premature ejaculation based on multiple clinical trials.
High concentration such as 50 mg per day improves PE condition positively but it is linked with an increased occurrence of adverse effects. Increased dosage with consistent use leads to side effects and the impact of delay in ejaculation worsens.
The recommended regular use of SSRI is between 3-6 months. Most physicians suggest using SSRI for PE daily for up to 3 months to avoid adverse effects.
Regular vs. On-Demand SSRI Dosage for PE
Daily use of SSRI for premature ejaculation is the recommended start as it helps your body get used to SSRI. Regular use on a daily basis is, however, restricted up to 3-6 months. Most men start experiencing side effects when they continue using SSRI for PE beyond 3 months.
On-demand use of SSRIs works best in the long term. On-demand refers to taking an SSRI 4-6 hours before sexual intercourse. This on-demand usage significantly lowers the risk of side effects as most men don’t have intercourse daily so it’s pointless to have SSRI daily.
Most clinical trials go with daily use of SSRI for PE up to 3 months (sometimes extending to 6 months depending on the dose and concentration). After an initial period of daily use, switching to on-demand works best as it lowers side effects and positively impacts the ejaculation duration.
Several studies reported an increase in adverse effects when men use SSRIs continuously daily. Most men stop taking SSRI for PE after using it for a couple of months due to worsening side effects like headache, dizziness, and nausea. On-demand addresses this issue and helps you avoid side effects while delaying orgasm.
SSRI Alternatives for Premature Ejaculation
1. Desensitizing Products
Numbing products like sprays, wipes, and creams are over-the-counter products for delaying ejaculation and treating premature ejaculation. Desensitizing products don’t have any side effects like SSRIs, don’t require a prescription, and work instantly. Numbing products work in a few minutes and their effect lasts up to an hour.
Topical numbing products are applied to the penis a few minutes before intercourse. They work by reducing the sensation of your penis which helps you last longer in bed by delaying orgasm. Desensitizing products are made from topical anesthetics or natural ingredients.
Quick recommendation: Try No More PE Herbal Delay Spray that’s 100% natural spray made from herbal ingredients with no side effects. It has a mild numbing effect that ensures you enjoy sexual intercourse and don’t feel completely numb.
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2. OTC Supplements
Over-the-counter supplements offer a natural way to delay orgasm without any side effects. Supplements are available in the form of tablets and capsules made from herbal ingredients that boost your ability to delay climax during sexual intercourse.
Herbal supplements for premature ejaculation don’t work instantly like numbing products and on-demand SSRIs. You have to use supplements regularly for 2-3 months to make it work. The ingredients in the supplement help you increase ejaculation timing naturally over time.
ProSolution Plus is a scientifically proven supplement for PE that has no side effects. A study reported that ProSolution Plus improves PE in men by 68% with a significant increase in sexual satisfaction.
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3. Home Remedies
Natural home remedies are also helpful in delaying climax. Fruits and vegetables are scientifically known to improve premature ejaculation. Food rich in magnesium and zinc significantly help in improving PE by increasing ejaculation time.
Home remedies for premature ejaculation require lifestyle changes. It requires consistency as natural remedies for PE don’t work quickly like SSRIs and delay products. You have to stick with a strictly maintained routine and lifestyle to benefit from home remedies. This is where it gets a bit challenging as most men need an immediate solution and don’t have much time to wait for months.
The good thing about natural remedies for PE is that these are extremely cheap and have no adverse effects. Maintaining a healthy lifestyle doesn’t hurt you and it comes with other benefits too. So, it’s a win-win.
4. Exercise and Therapies
Behavioral techniques, therapies, counseling, and exercises are also helpful in the treatment of premature ejaculation. You require assistance from an expert for counseling and therapy sessions. Exercise and behavioral techniques can be done with practice at home.
These techniques don’t have side effects and are usually quite effective in delaying orgasm and overcoming PE. For example, the squeeze technique is a popular, scientific behavioral technique that requires you to squeeze your penis during intercourse when you are about to climax. Stopping for 30-60 seconds at the climax and then resuming intercourse helps you last longer without any medicine or topical product.
Techniques and exercises like these require practice and consistency. It’s hard to master but once you are through, you get significant control over ejaculation and can last as long as you want.
This blog post on ways to hold back from cumming discusses the 10 best methods to last longer in bed naturally.
Final Words
Selective serotonin reuptake inhibitors are among the best drugs for premature ejaculation. They are used as the first medicine for managing PE. The lack of an approved drug for PE by the FDA forces medical experts to use SSRI as off-label.
The effectiveness of SSRIs varies and depends on factors like what type of SSRI you are using, its concentration, dose, duration, etc., Generally, SSRIs are quite effective and work great with minimal side effects. The long-term daily use of SSRI isn’t recommended as it leads to severe side effects.
Paroxetine is the best SSRI for PE as it has minimal side effects and works great for delaying ejaculation. Multiple clinical trials reported its efficacy for lifelong and secondary PE.
You can always switch to SSRI alternatives to fight PE if you want to avoid the side effects of SSRI. Delay products, supplements, home remedies, and behavioral techniques are the top alternatives with desensitizing products like delay sprays among the best alternatives. These delay products work instantly and have minimal side effects.
Consult your doctor for medical advice on SSRI for PE and further help.