From the Guidelines
Selective Serotonin Reuptake Inhibitors (SSRIs) used for premature ejaculation can cause several side effects, including nausea, headache, dry mouth, insomnia, drowsiness, dizziness, and decreased libido, as reported in the most recent guideline 1.
Common Side Effects
The most common side effects of SSRIs for premature ejaculation include:
- Nausea
- Headache
- Dry mouth
- Insomnia
- Drowsiness
- Dizziness
- Decreased libido These side effects are similar to those reported in patients being treated for depression, but the frequency and severity may be less due to the lower doses used for premature ejaculation 1.
Less Common Side Effects
Some men may experience less common side effects, such as:
- Erectile dysfunction
- Difficulty achieving orgasm
- Gastrointestinal issues like diarrhea or constipation
- Serotonin syndrome, a potentially serious complication associated with simultaneous use of multiple serotonergic drugs 1
Management of Side Effects
If side effects become bothersome, patients should consult their healthcare provider rather than discontinuing the medication abruptly, as this could lead to withdrawal symptoms 1. Patients should be advised to avoid sudden cessation or rapid dose reduction of daily dosed SSRIs to prevent SSRI withdrawal syndrome 1.
Recommended Treatment
The American Urological Association (AUA) and the Sexual Medicine Society of North America (SMSNA) recommend daily SSRIs, on-demand clomipramine or dapoxetine, and topical penile anesthetics as first-line agents of choice in the treatment of premature ejaculation 1. The choice of treatment should be based on the individual patient's needs and medical history, and patients should be closely monitored for side effects and efficacy.
From the Research
Potential Side Effects of SSRIs in Treating Premature Ejaculation
The use of Selective Serotonin Reuptake Inhibitors (SSRIs) to treat premature ejaculation (PE) has been studied in various research papers. Some of the potential side effects of SSRIs in treating PE include:
- Nausea 2
- Dizziness 2
- Headache 2
- Adverse events associated with other SSRIs, such as paroxetine, including a risk ratio of 1.5 for adverse events 3
- Risk ratios for adverse events associated with other treatments, including 4.1 for topical anesthetics, 2.4 for tramadol, and 1.8 for dapoxetine 3
Efficacy and Safety of SSRIs in Treating PE
The efficacy and safety of SSRIs in treating PE have been confirmed in many well-designed controlled trials 4. Dapoxetine, a type of SSRI, has been shown to be effective and safe in treating PE, with significant improvements in intravaginal ejaculatory latency time (IELT) and Premature Ejaculation Profile (PEP) items 2. However, the use of SSRIs can be associated with adverse events, and the risk of these events should be taken into consideration when treating PE 5.
Comparison of SSRIs with Other Treatments
SSRIs have been compared with other treatments for PE, including topical anesthetics, phosphodiesterase type 5 inhibitors (PDE5is), and tramadol. While these treatments have been shown to be effective in increasing IELT, the efficacy of SSRIs remains unclear due to high heterogeneity in the available randomized controlled trial (RCT) data 6. However, dapoxetine has been shown to be effective in increasing IELT, with a modest but statistically significant improvement compared with placebo 6.