What are Selective Serotonin Reuptake Inhibitors (SSRIs)?

From the Guidelines

SSRIs, such as fluoxetine, paroxetine, and sertraline, are effective in treating premature ejaculation, with dosages ranging from 5-20 mg/day for fluoxetine, 10-40 mg/day for paroxetine, and 25-200 mg/day for sertraline, as evidenced by the study published in The Journal of Urology 1. When considering treatment options for premature ejaculation, it is essential to weigh the benefits and risks of SSRIs. The study published in The Journal of Urology 1 provides guidance on the dosing regimens for various SSRIs, including fluoxetine, paroxetine, and sertraline.

Key Considerations

• The optimal dosage and administration regimen for SSRIs in treating premature ejaculation may vary depending on the individual patient's needs and response to treatment, as noted in the study 1.
• Common side effects of SSRIs, such as nausea, dry mouth, and reduced libido, should be considered when prescribing these medications for premature ejaculation, as reported in the study 1.
• Patients should be informed about the potential risks and benefits of SSRIs and monitored closely for any adverse effects, as recommended in the study 1.

Dosing Regimens

• Fluoxetine: 5-20 mg/day, with some studies suggesting a clinically beneficial effect at daily doses as low as 5 mg, as reported in the study 1.
• Paroxetine: 10-40 mg/day, with the majority of evidence supporting a daily dose of 20 mg, as noted in the study 1.
• Sertraline: 25-200 mg/day, with higher doses potentially increasing efficacy but also potentially associated with increased frequency of erectile dysfunction and decreased libido, as suggested in the study 1.

Administration Regimens

• Continuous daily dosing: This regimen is often used for patients with frequent sexual activity, as noted in the study 1.
• Situational dosing: This regimen may be beneficial for patients with less frequent sexual activity, as suggested in the study 1. It is crucial to consider the individual patient's needs and response to treatment when selecting an SSRI and administration regimen for premature ejaculation, as evidenced by the study published in The Journal of Urology 1.

From the FDA Drug Label

Male and Female Sexual Dysfunction With SSRIs Although changes in sexual desire, sexual performance, and sexual satisfaction often occur as manifestations of a psychiatric disorder, they may also be a consequence of pharmacologic treatment In particular, some evidence suggests that selective serotonin reuptake inhibitors (SSRIs) can cause such untoward sexual experiences. Reliable estimates of the incidence and severity of untoward experiences involving sexual desire, performance, and satisfaction are difficult to obtain, however, in part because patients and physicians may be reluctant to discuss them Accordingly, estimates of the incidence of untoward sexual experience and performance cited in product labeling, are likely to underestimate their actual incidence In placebo-controlled clinical trials involving more than 3,200 patients, the ranges for the reported incidence of sexual side effects in males and females with major depressive disorder, OCD, panic disorder, social anxiety disorder, GAD, and PTSD are displayed in Table 6.

SSRIs can cause sexual dysfunction, including:

• Decreased libido
• Ejaculatory disturbance
• Impotence
• Orgasmic disturbance The exact incidence of these side effects is difficult to determine due to underreporting, but they are a known potential consequence of SSRI treatment 2.

From the Research

Overview of SSRIs

• SSRIs, including fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram, are an important advance in the pharmacotherapy of mood and other disorders 3
• They are chemically unrelated to tricyclic, heterocyclic, and other first-generation antidepressants 3
• SSRIs are the treatment of choice for many indications, including major depression, dysthymia, panic disorder, obsessive-compulsive disorder, eating disorders, and premenstrual dysphoric disorder 3

Efficacy and Side Effects

• A meta-analysis of 20 short-term comparative studies of 5 SSRIs has shown no difference in efficacy between individual compounds but a slower onset of action of fluoxetine 4
• The most common adverse reactions to SSRIs were gastrointestinal (especially nausea) and neuropsychiatric (particularly headache and tremor) 4
• Side effects of SSRIs include gastrointestinal disturbances, headache, sedation, insomnia, activation, weight gain, impaired memory, excessive perspiration, paresthesia, and sexual dysfunction 3

Pharmacokinetics

• The five SSRIs have similar antidepressant efficacy and a similar side effect profile, but differ in their pharmacokinetic properties 5
• Under steady-state concentrations, their half-lives range between 1 and 4 days for fluoxetine (7 and 15 days for norfluoxetine) and between 21 (paroxetine) and 36 (citalopram) hr for the other SSRIs 5
• SSRIs underlie an extensive metabolism with high interindividual variability, whereby cytochrome P450 (CYP) isoenzymes play a major role 5

Long-term Use

• The major benefit of long-term SSRI use is relapse prevention 6
• The current literature suggests that the general health risks of long-term SSRI use are low; however, further research, particularly in special populations including youth and the elderly, is needed 6
• Long-term SSRI use increases the risk of tachyphylaxis and discontinuation syndrome 6

Adverse Effects

• One of the more controversial adverse effects of SSRIs is the black box warning for increased risk of suicidality in children and young adults aged 18-24 7
• Adults, who do not have certain risk factors, which could be confounding factors, do not seem to carry this increased risk of suicidality 7
• When prescribing SSRIs to any patient, a risk-benefit analysis must factor in the potential treatment effects, adverse effects, and dangers of the illness to be treated 7