Dapoxetine for treatment of premature ejaculation

Abstract

According to Jon Pryor and colleagues (Sept 9, p 929), dapoxetine is eff ective and well tolerated in the treatment of men with moderateto-severe premature ejaculation. Dapoxetine is a short-acting selective serotonin reuptake inhibitor (SSRI) which proved to be eff ective when taken 1–3 h before sexual intercourse. The most common adverse eff ects during the 12-week trial were nausea, diarrhoea, headache, and dizziness, all less frequent than 10%. However, Pryor and colleagues did not discuss possible adverse eff ects of longterm use of dapoxetine. What are the possible eff ects of repetitive administration of a highly potent SSRI compound? There is some evidence that SSRI drugs can induce bipolar disorder if the patient is not taking mood stabilisers. Clinical experience also indicates that repetitive discontinuation of antidepressants could reduce their effi cacy, as does repetitive discontinuation of neuroleptic treatment for schizo phrenia. Pryor and col leagues suggest that the underlying pathophysiology of premature ejaculation is related to diminished serotonergic neurotransmission through pathways that control ejaculation. Psychopharmacological studies suggest that depression might also be related to diminished serotonergic neurotransmission. Thus, what is the expected eff ect of SSRI drugs in a man who has for years used dapoxetine for the treatment of pre mature ejaculation and now falls into depression?