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Premature ejaculation (PE) is one of the most common male sexual dysfunctions, affecting millions of men globally. Premature ejaculation happens when a man ejaculates earlier than he or his partner would like, often before or just after starting intercourse. This condition can cause stress and problems in relationships. Research shows that around 20% to 30% of men may face this issue during their lifetime.
Selective Serotonin Reuptake Inhibitors (SSRIs), originally developed for treating depression, have shown promising results in delaying ejaculation. Some SSRIs are now commonly prescribed off-label to help men gain better control over their ejaculation. Among these, dapoxetine, commonly known by the brand name Everlong in Pakistan, stands out as the only SSRI specifically designed and approved for the treatment of premature ejaculation.
This comprehensive guide explores how SSRIs help treat PE, compares different SSRI options, discusses dosing strategies, and helps readers decide whether this treatment is suitable for them. It also covers alternative options and frequently asked questions to ensure a well-rounded understanding of the subject.
Premature Ejaculation (PE) means ejaculating too quickly during sex, often within a minute. SSRIs, commonly used for depression, can help delay ejaculation and improve control, making them a useful treatment option for PE.
Premature ejaculation is defined clinically as ejaculation that always or nearly always occurs within one minute of vaginal penetration, with an inability to delay ejaculation on all or nearly all occasions. It can be classified as:
PE can negatively impact mental health, cause relationship stress, and reduce sexual satisfaction. It is a medical condition that deserves proper attention and treatment.
SSRIs increase serotonin levels in the brain, which can delay the ejaculatory reflex. This effect is often a side benefit noticed in patients taking SSRIs for depression. For PE treatment, SSRIs work by:
SSRIs can be used daily or on demand, depending on the specific drug and patient needs. Onset of effect and time to peak efficacy vary across SSRIs.
Several SSRIs have shown effectiveness in delaying ejaculation, but their usage, timing, and side effects may vary—here’s a breakdown of the most commonly used options.
Dapoxetine is the only SSRI specifically developed and approved for the treatment of premature ejaculation. Taken 1 to 3 hours before sexual activity, it offers an on-demand dosing schedule that suits men who prefer not to take daily medications. Its fast onset and rapid elimination mean that it does not accumulate in the body, reducing the likelihood of long-term side effects.
Clinical studies have consistently shown that dapoxetine significantly increases IELT (Intravaginal Ejaculatory Latency Time) by 3–4 times. Because of its effectiveness, tolerability, and minimal impact on daily routine, it is often considered the gold standard in PE treatment. One of the most widely known brand names for dapoxetine is Everlong Tablets, which are frequently prescribed in countries like Pakistan and are known for their rapid action and reliability.
Sertraline is commonly used off-label for treating premature ejaculation. Unlike dapoxetine, it is taken daily, with dosages typically ranging from 25mg to 100mg. Most men begin to notice improvements in ejaculatory control within 2 to 4 weeks of starting the medication. It has shown solid results in increasing IELT but requires consistent use to maintain effectiveness.
The side effects of sertraline may include drowsiness, gastrointestinal discomfort, and reduced libido. Despite these potential drawbacks, it is generally well-tolerated and low-cost, making it a practical option for those who do not mind daily dosing.
Paroxetine is an SSRI that is commonly used off-label (not officially approved) to help treat premature ejaculation (PE). It is known for its strong serotonergic effect, which helps significantly delay ejaculation. It is taken daily at doses ranging from 10mg to 40mg and usually shows effectiveness within two to three weeks.
However, paroxetine is also associated with a higher likelihood of sedation and sexual side effects like reduced libido or erectile dysfunction. Due to its daily dosing and side effect profile, it may not be ideal for men seeking a flexible, on-demand treatment.
Fluoxetine, commonly known as Prozac, is an SSRI with a long half-life, making it stay in the system longer than other options. It is taken daily at doses ranging from 10mg to 40mg. While it offers moderate improvements in IELT, it may take up to 3–5 weeks to see noticeable results.
This drug may cause side effects such as nausea, insomnia, or decreased sexual desire. Its long duration in the body and less convenient use compared to dapoxetine make it less preferred for PE treatment, though it remains a valid option.
Escitalopram has shown positive results in clinical trials for delaying ejaculation. Typically dosed at 5mg to 20mg per day, it is considered one of the more tolerable SSRIs, with fewer side effects compared to paroxetine.
Though not as fast-acting or convenient as dapoxetine, escitalopram may be a good fit for men with co-existing anxiety or depression who also struggle with PE. Its daily use can offer dual benefits in such cases.
Citalopram is a mild selective serotonin reuptake inhibitor (SSRI) that is sometimes used off-label to manage premature ejaculation (PE. It is usually taken in daily doses of 10mg to 20mg and provides modest improvements in ejaculatory delay. It has a gentle effect on the nervous system and is often considered for men who are sensitive to other medications.
Common side effects can include dry mouth, feeling dizzy, and tiredness. While it may not be as effective as other SSRIs like paroxetine or sertraline, it can be a starting option for those new to SSRI-based treatments for PE.
Selective Serotonin Reuptake Inhibitors (SSRIs) are used in different dosing strategies depending on the patient’s needs, severity of premature ejaculation (PE), and any co-existing mental health conditions.
When choosing an SSRI for premature ejaculation, it’s essential to weigh both effectiveness and side effects. The right choice depends on individual goals—immediate results vs. long-term management.
SSRIs can be an effective medical option for men struggling with premature ejaculation, especially when non-drug methods have failed or proven insufficient.
Not all men prefer or respond well to SSRIs. Several non-SSRI options—both medical and non-medical—can help manage premature ejaculation, either alone or alongside primary treatments.
Effective management of premature ejaculation (PE) often requires close collaboration with a qualified healthcare provider. Being prepared and staying engaged can help tailor the most effective and safe treatment plan.
Below are answers to some of the most commonly asked questions about using SSRIs for premature ejaculation (PE), including how they work, side effects, and treatment options.
Dapoxetine starts working within 1 to 3 hours after intake, making it ideal for on-demand use. Traditional SSRIs like sertraline, fluoxetine, and paroxetine usually take 2 to 4 weeks of consistent daily use before showing noticeable improvement in ejaculation time.
For traditional SSRIs, stopping abruptly is not recommended. These medications need to be tapered off gradually under a doctor’s supervision to prevent withdrawal symptoms. In contrast, dapoxetine is taken only when needed and can be stopped at any time without tapering.
If SSRIs don’t provide the expected results, your healthcare provider might adjust the dose, switch to another medication, or recommend combining drug therapy with behavioral techniques like the stop-start or squeeze method for better results.
Yes, several natural options may help with premature ejaculation. Pelvic floor exercises, herbal remedies like ashwagandha and ginseng, and counseling can be effective for some men, especially when combined with lifestyle changes.
Starting with the lowest effective dose is the best way to reduce side effects. Staying hydrated and avoiding alcohol can also help minimize common issues like dizziness, nausea, or drowsiness.
Yes, but only under medical supervision. Some combinations, such as using SSRIs with tramadol or topical anesthetics, may increase the risk of side effects—including a serious condition called serotonin syndrome—so your doctor’s guidance is essential.
SSRIs, especially dapoxetine, provide effective relief for men struggling with premature ejaculation. While traditional SSRIs like sertraline, paroxetine, and fluoxetine have shown benefits, they come with daily-use burdens and more side effects.
On-demand use of dapoxetine offers convenience, fewer side effects, and high patient satisfaction. Make sure to talk to a qualified doctor or healthcare provider to find the most suitable treatment option for your condition.
Talk to your doctor about SSRIs for PE. Explore online pharmacies that offer dapoxetine legally in your region. Be patient, stay consistent, and keep communication open with your partner and healthcare provider.
