What is the role of selective serotonin reuptake inhibitors (SSRIs), and what kind of effect do they have?
A My suspicion is that SSRIs are what most physicians use to treat patients with this problem. They’re not indicated for this purpose, but they clearly have some efficacy. A variety of different agents have been used—fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft). Clomipramine (Anafranil) is a tricyclic antidepressant but, like the SSRIs, is centrally acting. The SSRIs seem to interfere with 5-HT receptors in the brain. The side effect of retarded ejaculation is well known among clinicians who use these agents in psychopharmacology. Q Phosphodiesterase type-5 inhibitors like sildenafil citrate (Viagra) seem to have an effect on premature ejaculation. Is that compelling data? A There actually are some interesting data on the use of PDE-5 inhibitors for this condition. One trial published a number of years ago looked at SSRIs and sildenafil separately. Sildenafil was shown to be as effective as SSRIs in patients who had PE (Int J Impot Res 2001; 13:41-5). There’s no que
