In this article, we will explore one of the most common treatments for premature ejaculation: sertraline.
By the end of the post, you will understand how it works, how to take it, its adverse effects, and whether it can affect other aspects of your sex life.
Sertraline hydrochloride (Zoloft) is a medication in the class of selective serotonin reuptake inhibitors (SSRIs).
These medications are used as anti-depressants. They may also aid in obsessive-compulsive disorder, social anxiety, and panic attacks.
All of the above are FDA-approved indications. However, there are also off-label uses, including bulimia, generalized anxiety, and premature ejaculation.
This means that the FDA does not directly recommend sertraline (Zoloft) or any SSRI for premature ejaculation. However, it is still used by many doctors with good results.
Premature ejaculation is a problem that affects one in three men in their lifetime. It can be a recurrent issue or a sporadic occurrence.
Premature ejaculation is a very rapid ejaculation shortly after penetration. Sometimes it happens before actually achieving penetration.
We can also divide premature ejaculation into the following:
- Mild premature ejaculation, in which ejaculation occurs 30 to 60 seconds after penetration.
- Moderate premature ejaculation, in which ejaculation occurs 15 to 30 seconds after penetration.
- Severe premature ejaculation, in which ejaculation occurs before penetration or immediately after.
Premature ejaculation can also be defined, according to the International Society for Sexual Medicine, as the inability to delay ejaculation in almost all or all cases of vaginal penetration. This ejaculatory control problem is severe enough to trigger relationship problems.
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Can sertraline help with premature ejaculation?
The causes of premature ejaculation can be multifactorial but sometimes include disorders in serotonin levels.
In some patients with premature ejaculation, sertraline can help stabilize their serotonin levels. In this way, sertraline may alleviate or improve some cases of premature ejaculation.
How does sertraline work for premature ejaculation?
The mechanism of action of sertraline consists of the inhibition of receptors that collect serotonin to be used again.
By not collecting the serotonin in the presynaptic space, it stays there longer. It can stimulate the neighboring neuron for a more extended period.
That’s why this type of antidepressant also works for premature ejaculation.
Therefore we could say that sertraline functionally increases serotonin levels, relieving symptoms of depression and improving some cases of premature ejaculation.
That is why sertraline has been used for many years and in numerous studies, demonstrating an extension of intravaginal ejaculation latency time (IELT).
In some cases, a significant increase in this parameter can be demonstrated using sertraline alone.
Researching sertraline for premature ejaculation, a recent systematic review and meta-analysis was published in Medicine in 2019.
The published data demonstrated that sertraline increases IELT BY 790%, with a sexual satisfaction rate of 41 to 51% after sertraline treatment, compared to 19 to 20% efficacy in the control group.
Similarly, the rate of partner sexual satisfaction was up to 57% in the sertraline group, compared to 11 to 14% in the placebo group.
In one specific study, sertraline increased partner sexual satisfaction from 14 to 88%.
As we have seen, the difference is significant. However, further studies also compare sertraline vs paroxetine and other agents for premature ejaculation.
They show that the most significant ejaculatory delay is caused by paroxetine, which can increase IELT by as much as 1492%.
This makes paroxetine the best SSRI for premature ejaculation, according to these authors.
How to take sertraline for premature ejaculation
Most studies of sertraline for premature ejaculation use the drug daily for at least six weeks.
Sertraline is taken daily in doses of 25, 50, or 100 mg. The dosage will depend on the severity of the case and other factors that your healthcare provider may consider.
A study of men between the ages of 22 and 63 showed that the effectiveness of sertraline is dose-dependent:
- 25 mg dose increases the latency period from one to seven minutes.
- 50 mg dose increases by over 13 minutes in the latency period.
- 100 mg dose can achieve an IELT increase of 16 minutes or slightly more.
- However, some patients may respond more to sertraline treatment, and some even reach a 20-minute latency period with a dose of as little as 25 mg.
Therefore, it is not always necessary to reach the maximum dose of sertraline to achieve greater effectiveness.
Moreover, lower doses are preferred if possible, as they decrease the risk of adverse effects.
In addition to daily use, sertraline can also be used for premature ejaculation according to an on-demand schedule. That is, 50 to 100 mg is taken on the same day of sexual activity.
But how and when to take sertraline for premature ejaculation? If you take sertraline daily, you can take it anytime, with or without food.
Just be careful to take the medication at the same time every day. If you experience sleeping problems, taking it in the morning is recommended.
On the other hand, if you take sertraline on an on-demand schedule, it is recommended to use the drug four hours before sexual intercourse.
Remember that sertraline may take a few weeks to take effect and may work differently in different people.
Therefore, it will be important to discuss this with your doctor to find the best schedule for you.
Side effects of Sertraline (Zoloft)
Sertraline is better tolerated and safer than tricyclic antidepressants and other drugs prescribed for depression. However, it can also have adverse effects.
The side effects of Sertraline (Zoloft) include:
- Dizziness and drowsiness
- Nausea and diarrhea
- Profuse sweating
- Fatigue and tremors
- Rhinitis
- Confusion and hallucinations
Special caution should be exercised in patients 65 years of age or older. In these patients, sertraline may cause a decrease in blood sodium levels, also known as hyponatremia.
This drug cannot be administered with monoamine oxidase inhibitors, such as methylene blue, linezolid, or pimozide.
Similarly, suicidal ideation has been reported in some cases after using sertraline, especially in patients between 18 and 24 years of age. Therefore, caution should be exercised in this age range.
Can sertraline cause side effects sexually?
Although it can relieve one type of sexual dysfunction, sertraline can cause another. Some patients may report sexual side effects at the other end of the spectrum.
In other words, instead of premature healing, they begin to experience erectile dysfunction or loss of libido.
In some cases, premature ejaculation can develop into anejaculation, i.e., an inability to achieve orgasm.
These sexual adverse effects usually occur with very high doses of sertraline or when administered incorrectly. Therefore, the medication should be taken precisely as prescribed by the treating physician.
Natural alternatives to sertraline
Ironically, one medication for sexual dysfunction has another sexual dysfunction as a risk. That’s why some patients consider alternative treatments apart from sertraline, including those laid down in the following table:
| Alternative | Pros | Cons |
| Sex therapy | Effective in the long run and treats the root cause when childhood trauma is involved. | It takes time to detect and treat the psychological causes of premature ejaculation. |
| Behavioral techniques | Inexpensive and applicable for each patient. For example, masturbating before intercourse and the stop-start technique. | Does not work the same for every patient. In some cases, treatment efficacy is not ideal and may not work, especially when biological causes are involved. |
| Desensitizing sprays with lidocaine | Work very well in patients with hypersensitive glans. | Numbing the penis may reduce sexual pleasure and affect erectile function in some cases. |
Conclusion
Sertraline is an antidepressant drug also used for the treatment of premature ejaculation. It is an off-label use, meaning that it serves this purpose in practice. However, it has not been directly recommended by the FDA.
There are two different ways to use sertraline for premature ejaculation.
One is daily use, in which it must be administered continuously, every day, preferably at the same time.
The second treatment schedule is on-demand. This means you can use sertraline as needed for premature ejaculation four hours before sexual intercourse.
Sertraline (Zoloft) is effective for premature ejaculation in a dosage of 25 mg to 100 mg. Higher doses generally lengthen the latency period further.
Still, excessive doses should be avoided as they carry a greater risk of adverse effects.
In some cases, an individual with premature ejaculation may experience other sexual problems when treated with sertraline, especially anejaculation, i.e., the inability to achieve orgasm. However, these adverse effects only occur with high doses of the drug.
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