Combination therapy with selective serotonin reuptake inhibitors and phosphodiesterase‐5 inhibitors in the treatment of premature ejaculation Efficacy of sertraline hydrochloride in treatment of premature ejaculation: a placebo-controlled study using a validated questionnaire Relevance of serum nitric oxide levels and the efficacy of selective serotonin reuptake inhibitors treatment on premature ejaculation: decreased nitric oxide is associated with premature ejaculation The efficacy of duloxetine in the treatment of premature ejaculation Duloxetine, dual serotonin and norepinephrine reuptake inhibitor, versus paroxetine, selective serotonin reuptake inhibitor, in the treatment for premature ejaculation Tadalafil and Fluoxetine in Premature Ejaculation: Prospective, Randomized, Double-Blind, Placebo-Controlled Study Efficacy and safety of dapoxetine in men with premature ejaculation and concomitant erectile dysfunction treated with a phosphodiesterase type 5 inhibitor: randomized, placebo-controlled, phase III study. Safety and Efficacy of Escitalopram in the Treatment of Premature Ejaculation: A Double-Blind, Placebo-Controlled, Fixed-Dose, Randomized Study On-demand tramadol hydrochloride use in premature ejaculation treatment. Treatment of premature ejaculation in the Asia-Pacific region: results from a phase III double-blind, parallel-group study of dapoxetine. Pilot evaluation of selective serotonin reuptake inhibitor antidepressants in hot flash patients under androgen-deprivation therapy for prostate cancer The efficacy of citalopram in the treatment of premature ejaculation: a placebo-controlled study On-demand use of tramadol, sildenafil, paroxetine and local anaesthetics for the management of premature ejaculation: A randomised placebo-controlled clinical trial Comparison Between Tadalafil Plus Paroxetine and Paroxetine Alone in the Treatment of Premature Ejaculation Maternal corticotropin-releasing hormone and the use of selective serotonin reuptake inhibitors independently predict the occurrence of preterm birth. Mirtazapine augmentation in depressed patients with sexual dysfunction due to selective serotonin reuptake inhibitors Comparison of moclobemide with selective serotonin reuptake inhibitors (SSRIs) on sexual function in depressed adults A pragmatic 12-week, randomized trial of duloxetine versus generic selective serotonin-reuptake inhibitors in the treatment of adult outpatients in a moderate-to-severe depressive episode The efficacy of fluoxetine in the treatment of premature ejaculation: a double-blind placebo controlled study. Time to response in panic disorder in a naturalistic setting: combination therapy with alprazolam orally disintegrating tablets and serotonin reuptake inhibitors compared to serotonin reuptake inhibitors alone. Duloxetine in obese binge eater outpatients: preliminary results from a 12‐week open trial Effect of buspirone on sexual dysfunction in depressed patients treated with selective serotonin reuptake inhibitors. Diminished Neural Processing of Aversive and Rewarding Stimuli During Selective Serotonin Reuptake Inhibitor Treatment
We aim ed to evaluate the effectiveness of paroxetine and tadalafil combination in the treatment of  premature ejaculation ( PE ) . A total of 150 primary (lifelong)PE patients were r and omly distributed into three groups of 50 patients each . Group 1 received 20 mg paroxetine every day for 1 month , Group 2 received 20 mg tadalafil on dem and 2 h before intercourse , and Group 3 received paroxetine and tadalafil on dem and 2 h before intercourse . Intravaginal ejaculatory latency times ( IELT ) scores were evaluated at baseline , at the end of the first month of therapy and 1 month after discontinuation of the treatment , while International Index of Erectile Function ( IIEF ) question naire scores were evaluated both prior to and after the treatment . At the end of the first month of therapy , IELT scores were compared with the basal values and statistically significant changes were detected ( 60.6 ± 30.2–117.3 ± 67.3 , 68.5 ± 21.4–110.2 ± 37.3 , 71.56 ± 40.23–175.2 ± 60.2)(P < 0.01 ) . IELT scores after discontinuation of treatment were found to be close to the baseline IELT scores ( P > 0.05 ) . IIEF scores were evaluated both prior to and after the treatment , and no statistically significant difference was detected ( P > 0.05 ) . It is concluded that utilisation of selective serotonin reuptake inhibitors ( SSRI ) and phosphodiesterase‐5 inhibitors ( PDE5i ) combination before intercourse seems to provide significantly longer ejaculatory latency times as compared with SSRI alone for a long time in patients with PE Selective serotonin reuptake inhibitors ( SSRIs ) are increasingly used to treat premature ejaculation . We report a large prospect i ve placebo-controlled crossover study of sertraline in premature ejaculation ( PE ) using Arabic Index of Premature Ejaculation ( AIPE ) . One hundred and forty-seven men suffering from PE were enrolled in a r and omized single-blinded crossover study of sertraline hydrochloride and placebo .  Patients were r and omized into group 1 ( n=77 ) and group 2 ( n=70 ) . Both groups received sertraline and placebo interchangeably for 4 weeks . Overall , 127 ( 81 % ) of 157 subjects experienced a significant increase in their AIPE total score after sertraline treatment . Sixty-six ( 66 % ) of 100 patients available for follow-up experienced relapse of PE within 6 months after sertraline withdrawal . The active drug was generally well tolerated . Our relatively large study , using a vali date d question naire ( AIPE ) , confirmed the useful effect of sertraline on PE The aim of the present study was to determine the relevance of serum nitric oxide levels and the efficacy of selective serotonin reuptake inhibitors ( SSRI ) treatment on  premature ejaculation . Sixty married men ( aged 20–50 ) with lifelong premature ejaculation and forty healthy men ( aged 24–48 ) as control group were included in this study . The patients were evaluated by  intravaginal ejaculation latency time ( IELT ) for premature ejaculation ( PE ) . IELT<1 min is accepted PE . Patients with diabetes mellitus , chronic disorders or erectile dysfunction and heavy smokers were excluded . All patients were evaluated with history , physical examination , International Index of Erectile Dysfunction‐5 ( IIEF‐5 ) score and IELT by stopwatch  method . Nitric oxide levels were measured by Griess reaction , and all sample s were frozen at −80 ° C . Patients were r and omly categorised 4 group to receive fluoxetine 20 mg day−1 ( Group 1 ) , paroxetine 20 mg day−1 ( Group 2 ) , sertraline 50 mg day−1 ( Group 3 ) and healthy control ( Group 4 ) for 4 weeks . Baseline and post‐treatment findings were compared between the four groups . At the end of 4 weeks , in fluoxetine , paroxetine , sertraline  groups mean IELT values showed a statistically significant improvement from the baseline values ( P < 0.001 , P < 0.001 , P = 0.03 ; respectively ) . Baseline and 1st month follow‐up mean IIEF scores were 24.5 and 23.05 , 24.70 and 23.60 ( P < 0.05 ) in group 1 and group 3 respectively ; also 23.09 and 23.32 ( P > 0.05 ) in group 2 . Baseline serum NO levels were 31.8 , 30.44 , 30.8 and 42.84 in fluoxetine , paroxetine , sertraline and healthy control groups respectively . NO levels were statistically lower in patients with PE . After treatment of fluoxetine , paroxetine and sertraline , NO levels were increased baseline ( 35.8 , 36.4 , 38.08 ) ( P < 0.05 ) . Our findings indicated that PE is associated with decreased serum NO levels . After the SSRI treatment increased , NO may retard ejaculation presumably by central peripheral mechanism . Further studies are needed to confirm this suggestion and the role of NO in pathophysiology and treatment for premature ejaculation Abstract Aim : Though premature ejaculation ( PE ) has been overshadowed by current attention given to erectile dysfunction , it is the most widespread form of male sexual dysfunction . Delayed or inhibited ejaculation , a known side effect of selective serotonin reuptake inhibitors ( SSRIs ) , has made SSRIs potentially useful in the treatment of this disorder . In the present study , we examined the efficacy of duloxetine , an SSRI , in the treatment of PE . Method : The study included 20 married patients diagnosed with PE . The patients were r and omly assigned to two groups , duloxetine ( group I ) and placebo ( group II ) , each consisting of 10 patients . The effects on the ejaculatory function were estimated by the intravaginal ejaculation latency time . All patients were evaluated by using clinical global impression-improvement Scale ( CGI-I ) . Results : The increase in the intravaginal ejaculation latency time in the duloxetine group was statistically significant than that of placebo group . Of group I patients , four ( 40 % ) were considered as “ very much improved ” and four ( 40 % ) “ much improved ” by CGI-I and only one of group II patients ( 10 % ) showed “ much improved ” . Conclusion : Duloxetine appears to be superior to placebo in the pharmacological treatment of PE when administered on a chronic basis Abstract Purpose In the current analysis due to the mechanism of effect , we evaluated the treatment benefit of duloxetine 40 mg comparing with paroxetine 20 mg , based on its effects on personal distress and interpersonal difficulty related to ejaculation , perceived control over ejaculation , and satisfaction with sexual intercourse , as well as the patient-reported global impression of change in premature ejaculation ( PE ) and the effect on intravaginal ejaculatory latency times ( IELT ) in men with premature ejaculation . Material s and methods The study included 80 married male patients diagnosed with lifelong PE . A total of 80 patients were r and omly distributed into two groups of 40 patients each . Group 1 patients received 40 mg duloxetine once a day for a month . Group 2 patients received 20 mg paroxetine once a day for a month . International index of erectile function question naire ( IIEF ) and IELT and PE profile were recorded before and after treatment . Results Comparing the groups ’ mean treatment IELT , there was no difference between groups . The IELT increase from baseline to treatment was 117 % in the duloxetine group ( P < 0.001 ) and 126 % in the paroxetine group ( P < 0.001 ) . There was no statistical difference between two groups in terms of IELT increase ( P > 0.05 ) . Also , there was no statistically significant difference between two groups at baseline IIEF to treatment IIEF scores . All PEP measures improved significantly with duloxetine and paroxetine groups ( P < 0.001 ) . Conclusion We think that duloxetine is safe and effective for the treatment for premature ejaculation Introduction : Premature ejaculation ( PE ) is a common male sexual disorder . An ideal , reliable and effective treatment is desired by many men and couples affected by this condition . Aim : Evaluate if the association of a phosphodiesterase-5 inhibitor , tadalafil , and a selective serotonin reuptake inhibitor , fluoxetine , can prolong the intravaginal ejaculatory latency time ( IELT ) in men with lifelong premature ejaculation . Methods : Sixty patients with lifelong premature ejaculation and without erectile dysfunction ( ED ) with IELT less than 90 s were enrolled in the protocol and r and omized into 4 groups to use a combination of medications : ( 1 ) tadalafil 20 mg plus fluoxetine 90 mg , ( 2 ) fluoxetine 90 mg plus placebo , ( 3 ) tadalafil 20 mg plus placebo , and ( 4 ) two different placebo capsules ( control ) . Before starting the medications , each man timed his IELT with a stopwatch , and likewise during the treatment period . Fluoxetine 90 mg or placebo was taken once a week plus tadalafil 20 mg or placebo within a 36-hour frame of intended sexual intercourse with a steady partner . Patients were prospect ively followed for 12 weeks . One-way ANOVA was used for statistical comparisons of IELT results in each group . Results : Mean IELT before starting treatment was 51.3 ± 23 s. Withone-way ANOVA , a statistically significant difference in post-treatment IELT was seen with combination treatment compared to placebo ( p < 0.001 ) . There were increases in IELT from baseline in patients using fluoxetine plus tadalafil ( 49.57 ± 25.87 to 336.13 ± 224.77 ) ( p < 0.001 ) , fluoxetine ( 56.55 ± 18.55 to 233.62 ± 105.08 ) ( p < 0.001 ) and tadalafil ( 49.26 ± 19.43 to 186.53 ± 159.05 ) ( p = 0.001 ) . The increases in each group were statistically significant compared to the placebo ( 49.86 ± 19.43 to 67.82 ± 46.18 ) ( p = 0.042 ) . Conclusion : Fluoxetine plus tadalafil significantly increased the IELT from baseline in men with lifelong premature ejaculation when compared to placebo , tadalafil or fluoxetine INTRODUCTION Men with comorbid erectile dysfunction ( ED ) and premature ejaculation ( PE ) may be concomitantly prescribed a phosphodiesterase type 5 ( PDE5 ) inhibitor and dapoxetine . AIM Evaluate efficacy and safety of dapoxetine 30 mg and 60 mg on dem and ( prn ) in men with PE and ED who were being treated with PDE5 inhibitors . METHODS This r and omized , double-blind , placebo-controlled , flexible-dose , multicenter study enrolled men ≥18 years who met diagnostic criteria for PE including intravaginal ejaculatory latency time ( IELT ) of ≤2 minutes in ≥75 % of sexual intercourse episodes ; were on stable regimen of a PDE5 inhibitor ; and had International Index of Erectile Function-erectile function domain score ≥21 . Subjects received placebo , dapoxetine 30 mg , or dapoxetine 60 mg prn ( 1 - 3 hours before intercourse ) for 12 weeks . MAIN OUTCOME MEASURE Stopwatch-measured average IELT , Clinical Global Impression of Change ( CGIC ) in PE , Premature Ejaculation Profile ( PEP ) , and treatment-emergent adverse events ( TEAEs ) . RESULTS Of 495 subjects r and omized , 429 completed the study . Arithmetic mean average IELT significantly increased with dapoxetine vs. placebo at end point ( 5.2 vs. 3.4 minutes ) and weeks 4 , 8 , and 12 ( P ≤ 0.002 for all ) . Men who described their PE at least " better " using the CGIC were significantly greater with dapoxetine vs. placebo at end point ( 56.5 % vs. 35.4 % ) and weeks 4 , 8 , and 12 ( P ≤ 0.001 for all ) . Significantly better outcomes were also reported with dapoxetine vs.  placebo on PEP measures . Incidence of TEAEs was 20.0 % and 29.6 % in placebo- and dapoxetine-treated subjects , respectively ( P = 0.0135 ) . TEAEs led to discontinuation in 1.6 % of subjects in both groups . Most frequent TEAEs were known adverse drug reactions of dapoxetine treatment including nausea ( 9.2 % ) , headache ( 4.4 % ) , diarrhea ( 3.6 % ) , dizziness ( 2.4 % ) , and dizziness postural ( 2.4 % ) . CONCLUSIONS In men with PE and comorbid ED on a stable regimen of PDE5 inhibitor , dapoxetine provided meaningful treatment benefit and was generally well tolerated Purpose : To evaluate the efficacy and safety of most selective serotonin reuptake inhibitor drug , escitalopram , in delaying ejaculation in patients with premature ejaculation ( PE ) . Material s and Methods : A total of 276 married men ( mean age , 34.4 years ) with PE were r and omly assigned to receive 10 mg of escitalopram ( n = 138 ; Group 1 ) or placebo ( n = 138 ; Group 2 ) for 12 weeks . Pretreatment evaluation included history and physical examination , intravaginal ejaculatory latency time ( IELT ) , International Index of Erectile Function ( IIEF ) , and Meares-Stamey test . The efficacy of 2 treatments was assessed every 2 weeks during treatment , at the end of study , and in 3- and 6-month follow-up after cessation of treatment . Results : At the end of 12-week treatment , the escitalopram group had a 4.9-fold ( 95 % confidence interval [ CI ] , 3.14 - 6.12 ) increase of the geometric mean IELT , whereas after placebo , the geometric mean IELT did not increase significantly ( 1.4-fold increase ; 95 % CI , 0.86 - 1.68 ; P = 0.001 ) . Baseline mean intercourse satisfaction domain values of IIEF 10 and 11 reached to 16 and 10 at 12-week treatment in Groups 1 and 2 , respectively ( P = 0.01 ) . At the end of 6-month follow-up period , the geometric mean IELT in escitalopram and placebo group demonstrated 3.1- ( 95 % CI , 2.16 - 4.4 ) and 1.3-fold ( 95 % CI , 0.78 - 1.62 ) increase , respectively ( P = 0.001 ) . Three- and 6-month intercourse satisfaction domain values of IIEF were 15 and 14 in Groups 1 and 10 and 10 ( P = 0.01 ) in Group 2 , respectively . Mean number of adverse events was 22 for escitalopram and 9 for placebo ( P = 0.04 ) . Conclusions : Oral escitalopram is an effective treatment for PE with long-term benefit for the patient after it is withdrawn . Further studies are required to draw final conclusions on the efficacy of this drug in PE OBJECTIVES To determine the efficacy of tramadol in premature ejaculation ( PE ) treatment compared with placebo . METHODS A single-blind , placebo-controlled , crossover study was conducted with 60 lifelong ( primary ) patients with PE . The patients were r and omized into 2 groups , each consisting of 30 patients , who took tramadol or placebo on dem and . PE was defined as an intravaginal ejaculation latency time of ≤60 seconds in 90 % of intercourse episodes . The efficacy of the drugs was assessed using the intravaginal ejaculation latency time , ability of ejaculation control , and sexual satisfaction scores after an 8-week treatment period . RESULTS All participants completed the study voluntarily . Two groups were similar in terms of the patient demographics . Increases in the intravaginal ejaculation latency time , ability of ejaculation control , and sexual satisfaction score between the placebo and tramadol groups were compared with the baseline values in both groups . At the end of study period , the tramadol group had significantly ( P<.001 ) greater values for all 3 parameters compared with those in the placebo group . CONCLUSIONS On-dem and use of low-dose tramadol is effective for lifelong PE . Currently , selective seratonin reuptake inhibitors such as dapoxetine , are a more popular treatment option for PE . However , tramadol might be considered an alternative agent for primary PE treatment INTRODUCTION Dapoxetine is a short-acting selective serotonin reuptake inhibitor that was recently approved for the on-dem and treatment of  premature ejaculation ( PE ) . AIM To evaluate the efficacy and safety of dapoxetine 30 mg and 60 mg on dem and ( prn ) in men with PE from the Asia-Pacific region . METHODS This r and omized , double-blind , parallel-group ,  placebo-controlled trial enrolled men who were 18 years or older ; in a monogamous , heterosexual relationship for at least 6 months ; met the Diagnostic and Statistical Manual of Mental Disorders , fourth edition , text revision , criteria for PE for at least 6 months ; and had an intravaginal ejaculatory latency time ( IELT ) of 2 minutes or less in at least 75 % of sexual intercourse episodes . Subjects received placebo , dapoxetine 30 mg , or dapoxetine 60 mg prn ( 1 - 3 hours before intercourse ) for 12 weeks . MAIN OUTCOME MEASURES Stopwatch-measured Average IELT , the Premature Ejaculation Profile ( PEP ) , Clinical Global Impression ( CGI ) of change in PE , treatment-emergent adverse events ( TEAEs ) . RESULTS Of the 1,067 subjects r and omized , 858 completed the study .  Mean Average IELT increased from approximately 1.1 minutes at baseline ( across groups ) to 2.4 , 3.9 , and 4.2 minutes with placebo , dapoxetine 30 mg , and dapoxetine 60 mg , respectively , and geometric mean Average IELT increased from approximately 0.9 minutes at baseline ( across groups ) to 1.8 , 2.7 , and 3.1 minutes , respectively ( fold-increases of 2.0 , 2.8 , and 3.3 , respectively ) . All PEP measures and the CGI of change were significantly improved with dapoxetine vs. placebo at study endpoint ( P < or = 0.005 for all ) . The most common TEAEs with dapoxetine included nausea , dizziness , somnolence , headache , vomiting , diarrhea , and nasopharyngitis ; TEAEs led to discontinuation in 0.3 % , 1.7 % , and 5.1 % of subjects with placebo , dapoxetine 30 mg , and dapoxetine 60 mg , respectively . CONCLUSIONS Dapoxetine treatment significantly prolonged IELT and improved PEP measures and was generally well tolerated in men with PE in the Asia-Pacific region Purpose : Hot flash ( HF ) is a common side effect in prostate cancer patient undergoing and rogen-deprivation therapy ( ADT ) . In this study , we evaluated the efficacy of paroxetine ( selective serotonin reuptake inhibitors ( SSRIs ) ) for HF . Patients and methods : In total , 10 men with prostate cancer under ADH who were suffering with HF entered this study . Self-report question naire was used for the evaluation . Results : The average rating for HF frequency decreased ( P=0.009 ) and HF severity decreased ( P=0.0332 ) also , reported QOL score increased ( P=0.0218 ) . Conclusion : These preliminary data suggest that low dose ( 10 mg/day ) of antidepressant paroxetine can be helpful in the treatment of HFs in patients under ADT for prostate cancer . Further controlled studies are needed to more fully evaluate the efficacy of the SSRIs Background : Despite the limited number of available study comparing of their efficacy , selective serotonin re-uptake inhibitors ( SSRI ) have been thought to have beneficial effects for the patients with premature ejaculation . In the present study , we decided to examine the efficacy of citalopram , an SSRI , in the treatment of premature ejaculation . Method : The study was consisted of 26 married patients diagnosed with premature ejaculation according to Diagnostic and Statistical Manual of Mental Disorders Third Revised Version ( DSM-III-R ) . The patients were r and omly assigned to two groups , citalopram ( group I ) and placebo ( group II ) , each consisting of 13 patients . The effects of drug on the ejaculatory function were assessed by the intravaginal ejaculation latency time . Additionally , all patients were screened by using Clinical Global Impression-Improvement Scale ( CGI-I ) and Yonsei Sexual Function Inventory-II ( YSFI-II ) . Results : The increase in the intravaginal ejaculation latency time in the citalopram group was statistically significant than that of placebo group . In addition , with respect to the subscales of the YSFI-II scale , similar overall significant improvements were seen in the patients given citalopram compared to those given placebo . Of group I patients , five ( 38.5 % ) were considered as ‘ very much improved ’ and four ( 30.8 % ) ‘ much improved ’ by CGI-I and only one of group II patients ( 7.7 % ) showed ‘ much improved ’ . Conclusion : The patients treated with citalopram showed significantly greater improvement compared to the patients receiving placebo Abstract Objectives : To compare the clinical efficacy of the on-dem and use of four drugs in the management of patients with premature ejaculation ( PE ) , as the off-label use of selective serotonin-reuptake inhibitors and topical penile anaesthetics is frequently indicated for the management of patients with PE , and tramadol HCl and sildenafil citrate were also tried for managing this disorder , but with recommendations based on weak evidence . Patients and methods : This was a single-centre , single-blind , placebo-controlled clinical trial conducted on 150 patients who had PE for > 1 year . Patients were r and omised equally into five groups .  On-dem and tramadol , sildenafil , paroxetine , local lidocaine gel or placebo was given for patients in groups 1–5 , respectively . During the month before treatment , the intravaginal ejaculation latency time ( IELT ) and sexual satisfaction scores ( on a 0–5-point scale ) were measured and compared to the mean IELT and sexual satisfaction scores recorded during 4 weeks of on-dem and drug administration , with monitoring of any possible side-effects . Results : Tramadol-treated patients had a significantly longer mean ( SD ) IELT , of 351 ( 119 ) s , than the other groups . Local anaesthetic was significantly better than paroxetine in prolonging the IELT , at 278 ( 111 ) vs. 186 ( 65 ) s , respectively . The improvement in sexual satisfaction was significantly better in the sildenafil group , with a mean ( SD ) improvement of 2.9 ( 1 ) points , than in the paroxetine and local anaesthetic groups , at 2.2 ( 0.9 ) and 1.9 ( 0.9 ) points , respectively . Conclusions : The four drugs significantly improved IELT values over placebo . Tramadol was associated with significantly longer IELT values , whilst sildenafil induced significantly better sexual satisfaction than the other drugs . The four drugs had tolerable side-effects Background : Several recent studies have investigated the therapeutic role of phosphodiesterase type 5 ( PDE5 ) inhibitors in premature ejaculation ( PE ) used in the treatment of erectile dysfunction . Objectives : In the present research , the efficacy of paroxetine alone and paroxetine plus tadalafil was compared in patients referred because of premature ejaculation . Patients and Methods : This quasi-experimental study was performed on 100 consecutive 17 to 49-year-old potent men with premature ejaculation and without any clear organic disease . All patients had lifelong PE with an intravaginal ejaculation latency time ( IELT ) shorter than 1.5 minutes . Informed consent was obtained from all patients who were r and omly divided into two groups using a computer-generated r and om tabulation list . In group A , patients received 10 mg paroxetine daily , in addition to four hours before planned sexual activity . In group B , 10 mg paroxetine was taken daily , plus 10 mg tadalafil one hour before planned sexual activity . The duration of the intervention was six months and patients were evaluated for IELT three and six months after the beginning of therapy . Results : The mean age of patients in groups A and B were 33 ± 9.6 and 31.2 ± 9.3 years , respectively ( P = 0.368 ) . The mean number of intercourses were 1.08 ± 0.6 and 1.12 ± 0.6 per week in groups A and B , respectively ( P = 0.791 ) . Mean IELT at the 3-month follow up in groups A and B was 4.5 ± 1.5 and 5 ± 2.4 minutes , respectively ( P = 0.285 ) and at the 6-month follow up was 4.8 ± 1 and 5.3 ± 2 minutes , respectively ( P = 0.278 ) . Conclusions : The results of the study show that tadalafil can increase the mean IELT and can be used for treatment of premature ejaculation in combination with paroxetine INTRODUCTION Studies support the premise that chronic maternal stress may trigger a premature sequence of physiologic events ending in preterm birth ( PTB ) . Furthermore , chronic stress is highly correlated with depression and anxiety , which also are associated with PTB . However , some studies report that medication status rather than depression and /or anxiety may reflect the risk for PTB . Although the purpose of this small , preliminary study was to evaluate the association between chronic maternal stress and PTB , this report focuses on the unexpected finding of the association between maternal use of selective serotonin reuptake inhibitors ( SSRIs ) and PTB . METHODS A prospect i ve cohort study of 100 pregnant women included measures of contributors to chronic maternal stress and corticotropin-releasing hormone ( CRH ) .  Demographic and behavioral data included smoking , substance use , and use of medications for depression and anxiety . RESULTS Pregnant women who used SSRIs to treat depression and /or anxiety were nearly 12 times more likely to give birth before term when compared with women who did not use these medications . Women with CRH levels in the fourth quartile were 6 times more likely to give birth before term when compared with women whose CRH levels were in the lower 3 quartiles . No associations were found between SSRI use and CRH levels . DISCUSSION Associations between PTB and maternal use of SSRIs are not understood . It is important not to alter current approaches to the treatment of depression and anxiety without thorough discussion with women regarding the potential benefits and harms of various treatment options To evaluate the effect of mirtazapine augmentation in patients with sexual dysfunction induced by current selective serotonin reuptake inhibitor ( SSRI ) treatment OBJECTIVE To compare the emergent sexual effects of moclobemide and selective serotonin reuptake inhibitors ( SSRIs ) during acute and maintenance therapy in routine practice . METHOD 268 patients were evaluated for sexual function  at baseline , 6 weeks , 3 and 6 months of treatment using physician ratings and self-rating question naires . Patients received moclobemide , an reversible monoamine oxidase A inhibitor ( RIMA ) , or a SSRI ( fluoxetine , fluvoxamine , paroxetine , sertraline ) . RESULTS Baseline values were similar in all groups . Incidences of impairments of sexual functioning with treatment , whether clinical ly relevant or not , were 24.3 % with moclobemide and 61.5 % with SSRIs ( physician ratings ) , with no significant tolerance to these effects . There was a suggestion of differences between the SSRIs in their specific dysfunctions they cause . SSRIs ( 21.6 % of patients ) had about ten times the moclobemide rate ( 1.9 % ) of sexual dysfunction reported as adverse events . Antidepressant efficacy was comparable between treatments . CONCLUSION In patients for whom sexual function  is important or sexual dysfunction  is present , moclobemide should be considered a first line antidepressant Some evidence suggests that medications that modulate both serotonin and norepinephrine may be more effective than selective serotonin-reuptake inhibitors ( SSRIs ) in severe major depressive disorder ( MDD ) . This prospect i ve pragmatic trial tests this hypothesis . Patients with severe MDD were r and omly assigned to either duloxetine ( a serotonin and norepinephrine-reuptake inhibitor ) or physicians ’ choice of four generic SSRIs . Nonblinded , flexibly dosed treatment was used to mimic clinical practice . To address potential investigator bias , the patient-reported Quick Inventory of Depressive Symptomatology Self-Report ( QIDS-SR ) was used as the primary efficacy outcome measure . A total of 750 out patients ( 19.2 % , African descent ; 14.8 % , Hispanic ) were r and omized . The primary outcome , remission at week 12 by QIDS-SR , was numerically greater for duloxetine compared with SSRIs ( 36 vs. 32 % ) , but this difference was not statistically significant . Mean changes in secondary outcomes were significantly superior in favor of duloxetine for the Hamilton Depression Scale-17 item , the Brief Pain Inventory , and the Sheehan Disability Scale . Remission superiority on the QIDS-SR was not achieved . Significantly greater benefit for duloxetine compared with SSRIs was demonstrated on measures of pain and functioning . Study demographics suggest a more generalizable racial and ethnic population than is typical in r and omized clinical trials PURPOSE The efficacy of the selective serotonin re-uptake inhibitor fluoxetine in the treatment of premature ejaculation was examined . MATERIAL S AND METHODS The study comprised 17 patients with premature ejaculation who presented to the urology clinic of our medical school . In this double-blind study the patients were r and omized into treatment groups receiving 20 mg . fluoxetine daily for 1 week and 40 mg . daily afterward ( group 1 ) or 1 capsule placebo daily for 1 week and 2 capsules daily afterward ( group 2 ) . The groups were evaluated according to the latent period of intravaginal ejaculation . RESULTS The latent period of intravaginal ejaculation in group 1 was significantly longer than that in group 2 . Nausea , headache and insomnia were reported side effects . CONCLUSIONS Fluoxetine may be regarded as a safe and effective alternative in the treatment of premature ejaculation OBJECTIVE This study evaluated time to response in the treatment of panic disorder with a selective serotonin reuptake inhibitor ( SSRI ) or serotonin norepinephrine reuptake inhibitor ( SNRI ) combined with alprazolam orally disintegrating tablets ( ODT ) , or SSRI/SNRI alone . DESIGN Subjects were r and omized to eight weeks open-label treatment with alprazolam ODT ( 4 weeks treatment followed by 3 - 4 week taper ) combined with an SSRI or SNRI , or treatment with SSRI/SNRI alone . SETTING The study was conducted under naturalistic conditions at 62 primary care and 34 psychiatric practice s. PARTICIPANTS Male or female subjects ≥18 years of age diagnosed with panic disorder , with or without agoraphobia . MEASUREMENTS The primary efficacy measure was time to response , defined as ≥50-percent decrease from baseline Hamilton Rating Scale for Anxiety ( HAM-A ) total score . Secondary measures included change from baseline in HAM-A scores and the Clinical Global Impression of Improvement ( CGI-I ) and Patient Global Impression ( PGI ) scales . RESULTS The intent-to-treat ( ITT ) population comprised 245 subjects . There was no statistical difference between treatment groups in time to response in the ITT population ; however , a prospect ively defined per protocol analysis revealed a statistically significant earlier onset of effect in subjects receiving SSRI/SNRI plus alprazolam ODT ( P<0.05 ) . Mean change from baseline in HAM-A total score and clinician and patient measures of global improvement also showed statistically significant early advantages for combination therapy compared with SSRI/SNRI monotherapy . CONCLUSION Combined treatment of panic disorder with alprazolam ODT and an SSRI/SNRI may be associated with more rapid improvement in anxiety symptoms compared with an SSRI/SNRI alone Attempts have been made to find appropriate drug regimens to treat binge eating disorder ( BED ) . Several reports have examined the use of selective serotonin reuptake inhibitors ( SSRIs ) or mood stabilizers ; both serotonin and noradrenalin reuptake inhibitors ( SNRIs ) have been reported to be useful for binge eating , but the available data are limited . We evaluated the efficacy of duloxetine , an SNRI , in 45 obese patients who reported binge eating To evaluate the possible influence of buspirone on sexual dysfunction in depressed patients treated with a selective serotonin reuptake inhibitor ( SSRI )  , we analyzed data from a placebo-controlled trial design ed to explore the efficacy of buspirone as add-on treatment for patients not responding to an SSRI alone . At baseline , all patients met the criteria for a major depressive episode according to DSM-IV and had received citalopram or paroxetine during a minimum of 4 weeks without responding to the treatment .  Buspirone ( flexible dosage , 20 - 60 mg/day ) or placebo was added to the SSRI for 4 weeks ; the mean daily dose of buspirone at endpoint was 48.5 mg ( SD = 1.0 ) . Sexual dysfunction was evaluated using a structured interview . Before starting medication with buspirone or placebo , 40 % ( 47 of 117 ) reported at least one kind of sexual dysfunction ( decreased libido , ejaculatory dysfunction , orgasmic dysfunction ) . During the 4 weeks of treatment , approximately 58 % of subjects treated with buspirone reported an improvement with respect to sexual function ; in the placebo group , the response rate was 30 % . The difference between placebo and active drug treatment was more pronounced in women than in men . The response was obvious during the first week , with no further improvement during the course of the study . It is suggested that the effect of buspirone on sexual dysfunction is a result of a reversal of SSRI-induced sexual side effects rather than of an antidepressant effect of the drug Background Selective serotonin reuptake inhibitors ( SSRIs ) are popular medications for anxiety and depression , but their effectiveness , particularly in patients with prominent symptoms of loss of motivation and pleasure , has been question ed . There are few studies of the effect of SSRIs on neural reward mechanisms in humans . Methods We studied 45 healthy participants who were r and omly allocated to receive the SSRI citalopram , the noradrenaline reuptake inhibitor reboxetine , or placebo for 7 days in a double-blind , parallel group design . We used functional magnetic resonance imaging to measure the neural response to rewarding ( sight and /or flavor of chocolate ) and aversive stimuli ( sight of moldy strawberries and /or an unpleasant strawberry taste ) on the final day of drug treatment . Results Citalopram reduced activation to the chocolate stimuli in the ventral striatum and the ventral medial/orbitofrontal cortex . In contrast , reboxetine did not suppress ventral striatal activity and in fact increased neural responses within medial orbitofrontal cortex to reward . Citalopram also decreased neural responses to the aversive stimuli conditions in key “ punishment ” areas such as the lateral orbitofrontal cortex . Reboxetine produced a similar , although weaker effect . Conclusions Our findings are the first to show that treatment with SSRIs can diminish the neural processing of both rewarding and aversive stimuli . The ability of SSRIs to decrease neural responses to reward might underlie the question ed efficacy of SSRIs in depressive conditions characterized by decreased motivation and anhedonia and could also account for the experience of emotional blunting described by some patients during SSRI treatment
Conclusions PDE5Is were significantly more effective than placebo or SSRIs for treating PE , while SSRIs were better than placebo .
The combined treatment had better efficacy than PDE5Is or SSRIs alone
Purpose To clarify the efficacy of phosphodiesterase-5 inhibitors ( PDE5Is ) and selective serotonin reuptake inhibitors ( SSRIs ) in men with premature ejaculation ( PE ) .