Selective Serotonin Reuptake Inhibitors (SSRIs) are antidepressant medications that can also be used at low doses to treat premature ejaculation. These include medicines like sertraline (Zoloft®) and paroxetine (Paxil®). They increase the amount of serotonin in the brain and as a very common side effect, inhibit or slow down the onset of an orgasm, therefore delaying ejaculation.

Other common treatments include:

• Numbing creams, gels, sprays, and wipes to decrease sensation
• Behavioral modification therapy
• Counselling
• Using the “pause-squeeze” technique - you or your partner squeezes the glans (where the head meets the shaft of the penis) for 10 to 20 seconds, preventing ejaculation and decreasing the strength of the erection, before resuming stimulation after about 30 seconds

SSRIs (Sertraline and Paroxetine)

Dosing

• Take prescribed dose daily by mouth.
• Both sertraline and paroxetine may need to be titrated to find optimal dose (this will be prescribed by health care provider, if needed).
• If you miss a dose, take the tablet as soon as you remember. If it is less than 12 hours till your next dose, skip the dose and resume your usual dosing time. Do not double dose.
• Swallow the capsules whole. Do not crush or chew the capsules.
• Take with or without food.
• Can take in the morning or evening.

Side effects / safety considerations

SSRIs can increase suicidal thoughts. If this happens, seek emergency care.

Other side effects can occur and usually self-resolve when a few weeks of taking medications. These include:

• Feeling dizzy, sleepy, tired, or weak
• Constipation, diarrhea, stomach pain, upset stomach, throwing up, or decreased appetite
• Dry mouth 
• Trouble sleeping
• Sweating a lot
• Shakiness
• Yawning

Important Information

This medication should be gradually tapered. Abruptly stopping this medication can lead to withdrawal symptoms including mood swings, headache, tiredness, sleep changes, and brief feelings similar to electric shock.

It is rare, but these drugs can lead to a very serious condition called serotonin syndrome/toxicity. You are at higher risk if taking with other medications that increase serotonin. Seek emergency care if you are experiencing the following:

• Fast heartbeat
• Hallucinations
• Loss of coordination
• Severe dizziness
• Severe nausea/vomiting/diarrhea
• Twitching muscles
• Unexplained fever
• Unusual agitation/restlessness
• Painful or prolonged erection lasting four or more hours