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Delayed orgasm or anorgasmia appears to be a relatively common side-effect of SSRIs and is also commonly reported with TCAs and MAOIs. Impairment of orgasm has been reported in 8-75% of patients taking fluoxetine87-90 and 6-9% of patients taking paroxetine.91-93 These are generally likely to represent low estimates as one open study above found a much higher rate of impairment of orgasm when subjects were asked specifically about this.

Anorgasmia has been reported with all the commonly employed TCAs including clomipramine, imipramine, desipramine, nortriptyline and doxepine81,82 and MAOIs such as phenelzine.80 Rates of anorgasmia also vary widely in these studies. For example, in a study of sexual dysfunction in obsessive-compulsive disorder, 96% of patients treated with clomipramine described problems with orgasm!94 In another study 8.8% of patients treated with amitriptyline described delay in ejaculation.95 Clomipramine and SSRIs have been used with reported success to treat premature ejaculation (e.g., ref. 96).

Delayed orgasm or anorgasmia is likely to be related to increased neurotransmission through postsynaptic 5-HT2c receptors. Thus, treatment with the 5-HT antagonist cyproheptadine, which has high affinity for the 5-HT2C receptor, has been found to be effective in treating SSRI-,97,98 TCA- 99,100 and MAOI- 101,102 induced anorgasmia. However, the use of cyproheptadine has been reported to precipitate the relapse of depressive symptoms in some individuals.101-105

Other treatments for fluoxetine-induced anorgasmia that have been reported include yohimbine,78 and a number of direct and indirect dopaminergic agonists. These effects are probably a result of functional antagonism of the serotonergic action of fluoxetine (or other SSRIs). By blockade of a2-autoreceptors, yohimbine facilitates noradrenergic neurotransmission. The importance of dopaminergic input in ejaculatory function is demonstrated by the effects of direct dopaminergic agonists such as amantadine and indirect dopaminergic agonists such as dextroamphetamine and pemoline in reversing SSRI-induced anorgasmia.106 5-HT has an inhibitory effect on dopamine release in the brain, and dopaminergic fibers from the ventral tegmental area of the hypothalamus have been shown to mediate the ejaculatory response in the rat (see page 84).

Direct and indirect cholinergic agonists, such as neostigmine and bethanechol, have also been reported to reverse anorgasmia associated with the use of TCAs and MAOIs.82 Successful ejaculation thus appears to depend on a balance among various cholinergic, noradrenergic, dopaminergic, and serotonergic systems.

Painful ejaculation has been reported in some men treated with TCAs.107 This appears to be due to abnormal coordination of muscle contraction during ejaculation. Other unusual side-effects that have been reported include penile anesthesia with fluoxetine108 and yawning and multiple orgasm with clomipramine109 and fluoxetine.110 A similar syndrome of yawning, stretching and ejaculation has been described in rats treated with SSRIs.

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5 Secrets to Lasting Longer In The Bedroom

5 Secrets to Lasting Longer In The Bedroom

How to increase your staying power to extend your pleasure-and hers. There are many techniques, exercises and even devices, aids, and drugs to help you last longer in the bedroom. However, in most cases, the main reason most guys don't last long is due to what's going on in their minds, not their bodies.

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