Selective serotonin reuptake inhibitors in the treatment of premature ejaculation

<正> Objective To review and assess the update studies regarding selective serotonin reuptake inhibitors （SSRIs） in thetreatment of premature ejaculation （PE） and then provide practical recommendations and possible mechanismsconcerning state of the art knowledge for the use of SSRIs in alleviating PE.Data sources Using the Medline,48 articles published from January 1st,1996 to August 1st,2006 concerning the useof SSRIs and their possible mechanisms in alleviating PE were found and reviewed.Study selection PE,rapid ejaculation,early ejaculation and SSRIs were employed as the keywords,and relevantarticles about the use of SSRIs and their possible mechanisms in the treatment of PE were selected.Results Many kinds of SSRIs,such as fluoxetine,sertraline,paroxetine and citalopram,have widely been employed totreat PE.However,their effects are moderate and there is no a universal agreement about the kind,dose,protocol andduration.Dapoxetine,as the first prescription treatment of PE,may change this bottle-neck situation.SSRIs aresuggested to be used in young men with lifelong PE,and acquired PE when etiological factors are removed but PE stillexists.Phosphodiesterase 5 inhibitors （PDE5-Is） are suggested to be employed alone or combined with SSRIs whenSSRIs fail to treat PE or sexual dysfunction associated with SSRIs occurs.The protocol of taking drugs on demandbased on taking them daily for a suitable period is proposed to be chosen firstly.The possible mechanisms includeincreasing serotonergic neurotransmission and activating 5-hydroxytryptamine 2C (5-HT2C) receptors,then switching theejaculatory threshold to a higher level,decreasing the penile sensitivity and their own effect of antidepression.Conclusion The efficacies of the current SSRIs are moderate in the treatment of PE and they have not been approvedby the FDA,therefore new SSRI like dapoxetine needs to be further evaluated.