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By Rajnish Mago, MD (bio)
Which SSRI is most effective?
A systematic review of randomized, controlled clinical trials found that paroxetine was more effective than both escitalopram and fluoxetine (Zhang et al., 2019).
But, paroxetine has not been shown to be more effective than sertraline (Zhang et al., 2019). Note: The reason I say “it has not been shown” rather than “it is not” is that most studies are not designed or powered to be able to say that two treatments are NOT different. This research concept probably seems confusing to you and I will explain it further on another page on this website.
Are higher doses better?
We should first try relatively low doses of the antidepressant. But, if the premature ejaculation does not respond to treatment with a lower dose, a higher dose may be effective. For example, in one study, patients who did not respond to sertraline 50 mg/day had greater improvement when the dose was increased to 100 mg/day compared to continuing on 50 mg/day (Xu et al., 2014).
Xu G, Jiang HW, Fang J, Wen H, Gu B, Liu J, Zhang LM, Ding Q, Zhang YF. An improved dosage regimen of sertraline hydrochloride in the treatment for premature ejaculation: an 8-week, single-blind, randomized controlled study followed by a 4-week, open-label extension study. J Clin Pharm Ther. 2014 Feb;39(1):84-90. doi: 10.1111/jcpt.12115. Epub 2013 Dec 9. PubMed PMID: 24313633.
Zhang D, Cheng Y, Wu K, Ma Q, Jiang J, Yan Z. Paroxetine in the treatment of premature ejaculation: a systematic review and meta-analysis. BMC Urol. 2019 Jan 3;19(1):2. doi: 10.1186/s12894-018-0431-7. PubMed PMID: 30606186; PubMed Central PMCID: PMC6318994.
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