Sertraline for Premature Ejaculation

Premature ejaculation is a common sexual problem that affects at least 30 percent of people assigned male at birth. 

While there are no medications approved by the Food and Drug Administration (FDA) for the treatment of premature ejaculation, healthcare providers sometimes prescribe drugs off-label to treat the condition.

One such medication is the antidepressant sertraline (Zoloft).

In this article I’ll explain how sertraline may be effective for premature ejaculation.

Then I’ll discuss the common side effects and drug interactions of sertraline, as well as alternatives for treating premature ejaculation.

Lastly I’ll cover the risks and precautions of sertraline and when to see a doctor about concerns regarding ejaculation.

Sertraline for Premature Ejaculation

Premature ejaculation (PE) occurs when semen exits the penis sooner than the person desires or intends during sexual intercourse or other activity.

Infrequent PE is not cause for concern.

But if it becomes a pattern, premature ejaculation may interfere with quality of life and strain mental health and relationships.

Since there are no FDA-approved medications for premature ejaculation, a healthcare provider recommends treatment based on other symptoms, causes, or health conditions.

Sertraline (Zoloft) is one common medication prescribed off-label to treat premature ejaculation.

Sertraline is a selective serotonin reuptake inhibitor (SSRI) that is FDA-approved for the treatment of:

• Major depressive disorder
• Panic disorder
• Obsessive-compulsive disorder (OCD)
• Social anxiety disorder
• Post-traumatic stress disorder (PTSD)
• Premenstrual dysphoric disorder (PMDD)

Sertraline helps with these conditions by increasing how much serotonin is available to the brain.

Serotonin is a neurotransmitter that helps promote feelings of calm and emotional well-being.

People can end up with too little serotonin for many reasons, and sertraline can help restore balance.

Serotonin is also required for sexual activity, including to help with arousal and ejaculatory control.

If serotonin levels are too low, ejaculation may happen earlier than desired.

How quickly does sertraline work?

Sertraline is not a fast-acting drug.

It takes time to build up in the body.

For most conditions, including premature ejaculation, it takes around four weeks of consistent use to notice improvements.

Sertraline effectiveness

Sertraline is not approved by the FDA for treatment of PE because there have not been large clinical trials demonstrating a proven effect.

However, some small studies show improvements in ejaculatory function.

And a meta-analysis of 14 trials found that sertraline improved sexual satisfaction and ejaculation timing.

According to some research, using sertraline regularly or as-needed may both lead to improvements in premature ejaculation.

However, regular use appears to lead to more noticeable improvements, while as-needed use leads to fewer side effects.

Talk to your healthcare provider about how often you should take sertraline for PE.

Sertraline Side Effects

Like other SSRIs, sertraline may cause side effects.

Common side effects

Common side effects of sertraline include:

• Nausea
• Diarrhea
• Tremor
• Indigestion
• Decreased appetite
• Sweating
• Sexual side effects (decreased sexual desire, erectile dysfunction)

More serious side effects

Less commonly, sertraline may cause more serious side effects, such as:

• Seizures
• Bleeding problems
• Heart arrhythmias
• Suicidal thoughts or behavior
• Serotonin syndrome

If you experience thoughts of self-harm or suicide, seek emergency medical care immediately. 

Serotonin syndrome is a potentially life-threatening condition where too much serotonin accumulates in the brain, leading to symptoms such as excessive sweating, fever, fast heartbeat, and muscle stiffness.

If you notice these symptoms, seek care at an emergency department or call 911.

Sertraline Drug Interactions

SSRI antidepressants, including sertraline, may interact with many drugs.

Taking any of the following with sertraline increases the risk of severe complications:

• Monoamine oxidase inhibitors (MAOIs) like selegiline, rasagiline, phenelzine, and others
• Triptans like sumatriptan, zolmitriptan, and others
• Tricyclic antidepressants (TCAs) like amitriptyline and others
• Other selective serotonin reuptake inhibitors (SSRIs) like citalopram, escitalopram, fluoxetine, paroxetine, and others
• Serotonin-norepinephrine reuptake inhibitors (SNRIs) like venlafaxine, duloxetine, and others
• Non-steroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, naproxen, and others
• Anticoagulants like warfarin
• Opioid painkillers like codeine, morphine, tramadol, and others
• Alcohol
• Sedating antihistamines like diphenhydramine, hydroxyzine, and others
• Anticonvulsants like gabapentin, pregabalin, and others
• Herbal supplements like St. John’s wort
• Muscle relaxants like baclofen, cyclobenzaprine, and others
• Macrolide antibiotics like azithromycin, erythromycin, and others
• Azole antifungals
• Contraceptives

Sertraline Alternatives

A healthcare provider may recommend other treatment options such as the below for premature ejaculation:

• Other antidepressants: Other SSRIs like escitalopram (Lexapro), paroxetine (Paxil), and fluoxetine (Prozac) also have a side effect of delayed orgasm and may be an effective treatment for premature ejaculation.

• Phosphodiesterase-5 (PDE-5) inhibitors: Medications such as tadalafil (Cialis) and sildenafil (Viagra) are used to treat erectile dysfunction and may be effective for premature ejaculation. In some cases, a healthcare provider may prescribe a PDE-5 inhibitor along with an SSRI.

• Behavioral therapy: Behavioral techniques such as the squeeze stop-start method may help with or without medication. 

Risks and Precautions of Sertraline

Sertraline can increase the risk of suicidal thoughts or behavior in young adults.

If you experience any thoughts of suicide while taking sertraline, tell your medical provider immediately.

When taking sertraline, avoid consuming alcohol and illegal substances, as these can increase the side effects and may alter the way that the brain responds to sertraline.

Do not take sertraline if you take monoamine oxidase inhibitors (MAOIs) or if you have:

• Electrolyte imbalance (hyponatremia)
• Bipolar disorder
• Seizure disorders
• Angle-closure glaucoma
• Bleeding disorders

When to See a Doctor

If you experience premature ejaculation and it interferes with your sex life, speak with a healthcare provider.

They can determine whether your symptoms warrant PE treatment and recommend the most appropriate interventions.

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