Premature ejaculation (PE) may leave you frustrated and affect your confidence. Many men worry about not enjoying intimate moments fully.
You might feel embarrassed or even stressed about the situation. This is a real issue that affects many lives.
SSRIs offer a promising solution that works by slowing down brain signals related to ejaculation. These medications help extend your experience and boost satisfaction. In this article, you will learn how SSRIs work and understand their benefits. You will discover a treatment that aims to restore confidence and enjoyment.
| 🔑 Key Takeaways ➤ SSRIs help delay ejaculation and extend the sexual experience. ➤ Studies show that more men report feeling better when they use SSRIs. ➤ Men report higher satisfaction and a stronger sense of control with SSRIs. ➤ SSRIs can add about three minutes to the time before ejaculation. ➤ Side effects, such as nausea and dry mouth, occur more often with SSRIs. ➤ Some SSRIs work daily while others work on demand before intimacy. |
Mechanism of Action
Serotonin reuptake inhibitors, or SSRIs, help delay ejaculation. One study showed that serotonin acts like a brake in the brain. This chemical slows down the process of ejaculation by working along brain pathways.
The authors pointed out that three specific serotonin receptors play an important role. They are called:
- 5-HT1A
- 5-HT1B
- 5-HT2C
These receptors help control the signals that tell the body to ejaculate. You can think of them as tiny switches that manage the timing during sexual activity.
Data also shows that not all SSRIs work the same way. Paroxetine has been used over time to help delay ejaculation, and it shows a good effect. Dapoxetine, a short half-life SSRI, works on-demand and significantly increases the time before ejaculation occurs.
Both chronic and on-demand dosing of SSRIs have beneficial effects for men with premature ejaculation.
Even though the benefits are clear, the exact way SSRIs work remains a puzzle. More studies are needed to understand why all SSRIs are not equal in delaying ejaculation.
| ⚠️ Important Consideration SSRIs are not FDA-approved specifically for PE, but doctors commonly prescribe them off-label because they are effective in many cases. |
Clinical Evidence
When you have premature ejaculation, you might feel unhappy with your sexual experience. Studies show that taking SSRIs can help.
For example, one large Cochrane review examined 31 trials with over 8,000 men. They found that about 220 out of every 1,000 men taking a placebo reported feeling “better” after treatment.
In contrast, nearly 422 out of 1,000 men using SSRIs reported an improvement. In other words, SSRIs increased the chance of feeling better.
Improved Satisfaction and Control
The evidence continues to show that SSRIs not only improve your overall symptoms but also help with other important areas. The same review reported that when men took SSRIs, they were more satisfied with intercourse.
In one analysis, 278 out of every 1,000 men on placebo were satisfied, compared to 453 out of every 1,000 with SSRIs. Also, more men felt they had better control over ejaculation. Only 132 per 1,000 men felt they had good control when using placebo, but with SSRIs, this number rose to about 302 per 1,000.
One study even found that fewer men felt distressed by their condition when they used SSRIs. On placebo, about 353 out of 1,000 men reported feeling only “a little bit” or “not at all” distressed. With SSRIs, that number increased to about 544 per 1,000.
Ejaculatory Delay
Another finding from these reviews is that SSRIs can extend the time between vaginal penetration and ejaculation.
On average, the studies found that using an SSRI added about 3 minutes to the intravaginal ejaculatory latency time (IELT). However, the certainty of this result is lower, which means we are less sure about the exact number.
Side Effects and Safety
It is important to know that while SSRIs improve several symptoms, they may also cause more side effects.
In the reviews above, the rate of adverse events was higher with SSRIs. For example, one set of data shows that for every 1,000 men, about 243 on placebo reported side effects compared to about 416 on SSRIs.
Also, more men stopped their treatment because of these side effects. About 11 out of every 1,000 men on placebo withdrew from treatment, compared to around 41 out of 1,000 on SSRIs.
Another study explains that SSRIs come with side effects similar to those seen in depression treatment, even though the doses are lower. The common side effects include:
- Fatigue
- Nausea
- Diarrhea
- Dry mouth
- Decrease in libido
In addition, there is a risk of serotonin syndrome if you take these medications alongside other drugs that raise serotonin levels.
These side effects are important to consider. They matter because while SSRIs like paroxetine, fluoxetine, and sertraline help delay ejaculation, they can cause discomfort for some patients.
Paroxetine, for example, is noted for causing insomnia, anxiety, and even erectile dysfunction.
| 🧠 Putting It All Together If you are considering treatment for premature ejaculation, the evidence tells us that SSRIs can help make you feel better about your symptoms, improve your satisfaction with intercourse, and give you a stronger sense of control over ejaculation. However, the studies also warn that there is a higher chance of side effects and a higher rate of treatment withdrawal when using SSRIs. In other words, while many men do experience improvements, some may stop treatment because of unwanted effects. |
Common SSRIs Used
Here are the different commonly used SSRIs and how they work to delay ejaculation.
Dapoxetine
Dapoxetine is a fast-acting SSRI that is used on demand. According to a study, its short half-life means it is absorbed quickly and eliminated soon after, making it suitable for taking shortly before intercourse. This quick action helps increase the IELT and improves patient-reported outcomes.
In one review, dapoxetine was shown in several phase III trials to add around 2.3 to 2.7 minutes to the IELT compared to placebo. Although it is used off-label in many places, dapoxetine is specifically developed for PE and is approved in many countries for this use.
Paroxetine
Paroxetine is another SSRI commonly used for premature ejaculation treatment. It is often given daily because its effect builds over time. The same studies note that paroxetine delays ejaculation by increasing serotonin levels in the brain, which helps boost the time before ejaculation occurs.
However, its slow onset means that on-demand use is not as effective compared to daily dosing. Paroxetine is used off-label for premature ejaculation at doses much lower than those used for depression.
Sertraline
Sertraline is listed as one of the SSRIs used off-label to manage premature ejaculation. Like paroxetine, sertraline works by blocking the reuptake of serotonin, thereby increasing the serotonin available in the brain. This helps delay ejaculation and improve overall sexual satisfaction.
One review notes that sertraline is effective in increasing IELT when used at appropriate doses. It may be taken daily or, in some cases, on demand several hours before intercourse.
Fluoxetine
Fluoxetine is an older SSRI that is also used to treat premature ejaculation. Although it is usually prescribed for depression at higher doses, when used for premature ejaculation the doses are much lower. The same studies have shown that fluoxetine can improve ejaculatory control and reduce distress about rapid ejaculation.
The same review supports the use of fluoxetine by noting its effectiveness and tolerability when compared with other SSRIs. Its side effects are similar to those of other SSRIs, such as nausea and dry mouth, but it remains a useful option for many patients.
Citalopram
Citalopram is another SSRI highlighted in the same review. It is reported to increase the IELT and help reduce performance anxiety in patients with PE. Citalopram is thought to work by increasing serotonin levels in the synaptic space, which delays the ejaculation reflex.
In clinical studies, daily administration of citalopram at low doses has shown significant improvements in patient satisfaction and overall sexual performance. This drug is used off-label for PE, and controlled trials support its effectiveness.
Escitalopram
Escitalopram is the S-enantiomer of citalopram and is known for its high selectivity for serotonin receptors. This selectivity means that it can be effective with fewer side effects related to other neurotransmitter systems.
Daily treatment with escitalopram can produce a marked increase in IELT. Patients often report improvements in both ejaculatory control and overall sexual satisfaction. As with the other SSRIs, escitalopram is used off-label for premature ejaculation at doses lower than those used for treating depression.
Fluvoxamine
While it is an SSRI, some studies suggest that it is less effective than the other agents listed when it comes to delaying ejaculation.
In trials comparing several SSRIs, fluvoxamine showed only a minimal increase in IELT. Despite its use for depression and obsessive–compulsive disorder, fluvoxamine’s benefit for premature ejaculation may be limited compared to drugs like paroxetine or dapoxetine.
Dosage
Research shows these medicines can be used every day or only when needed. Here are the common doses and their effects:
| Drug | Dosage | Increase in Ejaculatory Time | Considerations |
| Dapoxetine | 30–60 mg on demand | 2.5–3 times longer | Taken 1–2 hours before sex |
| Paroxetine | 10–40 mg daily or on demand | About 8 times longer | Full effect in 2–3 weeks |
| Clomipramine | 12.5–50 mg daily or on demand | About 6 times longer | Can be used daily or as needed |
| Fluoxetine | 20–40 mg daily | About 5 times longer | Usually taken every day |
| Sertraline | 50–200 mg daily | About 5 times longer | Dose varies; taken daily |
| Citalopram | 20–40 mg daily | About 2 times longer | Usually taken every day |
Wrap Up
SSRIs can delay ejaculation and bring more satisfaction during intimate moments. SSRIs improve control and boost confidence. They work by slowing down key brain signals that prompt ejaculation.
While the benefits are promising, the risk of side effects is real. You must weigh the improvements against the discomfort that may arise. The choice to use SSRIs is personal and should be made with care. It is wise to discuss treatment options with your doctor.
Frequently Asked Questions
Can I take SSRIs only when needed for PE?
Some SSRIs, like paroxetine or sertraline, may work if taken a few hours before sex, but they are usually more effective when taken daily.
Do SSRIs affect sexual desire?
They may lower libido in some men, but others tolerate them well. If this happens, adjusting the dose or switching medications might help.
Can I stop taking SSRIs suddenly?
No, stopping suddenly may cause withdrawal symptoms like dizziness, anxiety, and nausea. It’s best to taper off under a doctor’s guidance.
Sources
- Giuliano, F., & Clément, P. (2006). Serotonin and premature ejaculation: From physiology to patient management. European Urology, 50(3), 454–466. https://doi.org/10.1016/j.eururo.2006.05.055.
- Sathianathen, N. J., Hwang, E. C., Mian, R., Bodie, J. A., Soubra, A., Lyon, J. A., Sultan, S., & Dahm, P. (2022). Selective serotonin re-uptake inhibitors for premature ejaculation in adult men: A Cochrane systematic review. World Journal of Men’s Health, 40(2), 257–263. https://doi.org/10.5534/wjmh.210155.
- Sathianathen, N. J., Hwang, E. C., Mian, R., Bodie, J. A., Soubra, A., Lyon, J. A., Sultan, S., & Dahm, P. (2021). Selective serotonin re‐uptake inhibitors for premature ejaculation in adult men. Cochrane Database of Systematic Reviews, 2021(3), CD012799. https://doi.org/10.1002/14651858.CD012799.pub2.
- Sathianathen, N. J., Hwang, E. C., Mian, R., Bodie, J. A., Soubra, A., Lyon, J. A., Sultan, S., & Dahm, P. (2021). Selective serotonin re‐uptake inhibitors for premature ejaculation in adult men. Cochrane Database of Systematic Reviews, 2021(3), CD012799. https://doi.org/10.1002/14651858.CD012799.pub2.
- Roberts, M. J., Perera, M., Chung, E., & Gilbert, B. (2015). Premature ejaculation: A clinical review for the general physician. Australian Family Physician, 44(10). Retrieved from https://www.racgp.org.au/afp/2015/october/premature-ejaculation-a-clinical-review-for-the-ge
- Giuliano, F., & Clément, P. (2006). Serotonin and premature ejaculation: From physiology to patient management. European Urology, 50(3), 454–466. https://doi.org/10.1016/j.eururo.2006.05.055.