I took the plunge and went to a walk in clinic with documents in hand and managed to convince the GP to prescribe me paxil 10mg, although I lead him to believe it was for depression with PE. I’m going to start it within the next week, after I get over a minor injury due to clamping. When positive PI’s return, I’m popping the paxil!
I remembered I had a subscription to this journal, so I went back and dug out some interesting excerpts from a study regarding this PE subject. Hope you enjoy it as I did.
The Journal of Sexual Medicine – Volume 2, Number 1, 2005
http://www.blac kwellpublishing … 743-6095&site=1
On-Demand SSRI Treatment of Premature Ejaculation:
Pharmacodynamic Limitations for Relevant Ejaculation Delay and Consequent Solutions
Marcel D. Waldinger, MD, PhD, Dave H. Schweitzer, MD, PhD, and Berend Olivier, PhD
Chronic Administration of SSRIs
“Chronic Administration of SSRIs leads to a number of adaptations. The ongoing blockade of 5-HTTs results in a persistent increase of 5-HT levels in the synaptic cleft and around somatodendritic cell bodies. This leads to desensitization of 5-HT(1a) auto receptors over the course of weeks, possibly also to desensitization of 5-HT(1b) auto receptors, and consequently to less inhibition on 5-HT release into the synaptic cleft. The net effect of chronic SSRI administration is thus a stronger enhancement of 5-HT neurotransmission with a consequently stronger activation of post synaptic 5-HT receptors compared with acute SSRI administration.”
…”The results of this study may lead to the conclusion that blocking 5-HT(1a) receptors does not change ejaculatory latency under physiological conditions, but does so during SSRI treatment. The results of this study suggest also that 5-HT(1a) receptor functioning is essential in the effects of SSRIs on ejaculation. The question arises whether desensitization of this receptor could be held responsible for this effect. In this respect, it is intriguing that a recent male rat study demonstrated that chronic SSRI treatment, particularly paroxetine, impairs 5-HT(1a) receptors involved in ejaculation.”
…”Based on these mechanisms, at least two differently acting serotonergic agents (or one agent with the two mechanisms built into one molecule) are needed in order to obtain immediate and strong ejaculation-delaying effects”…….”in male rats it has been clearly demonstrated that 5-HT neurotransmission and post synaptic 5-HT receptor activation can be increased by co administration of a 5-HT(1a) receptor antagonist and an SSRI, resulting in an immediate strong delay of ejaculation.”
…”Pharmaceutical companies are encouraged to invest in the development of a new drug with a combined SSRI and 5-HT(1a) receptor antagonist mechanism.”
…”On-demand mono-SSRI treatment will never lead to similar impressive ejaculation delay as has been found after prolonged daily treatments.”