Prozac makes a night of it

Sex therapists have found a new solution to the age-old problem of premature ejaculation. Prozac, the "happy" drug which promotes the feel-good factor among the angst-ridden middle class, has also been found to delay the male climax.

Premature ejaculation - defined as ejaculation that occurs too soon for a couple to feel it is satisfying for their sex life - is by far the most common sexual problem affecting men. Suffered on a regular basis, it can lead to a loss of sexual desire, and even impotence, and can cause serious relationship problems. At present, sex therapists mainly use behavioural therapy for PE, teaching men to exercise control over ejaculation by using the "stop-start" or the "squeeze" technique. But while this can be effective for couples committed to a long-term approach, research suggests most men relapse within two years.

Prozac is one of a relatively new group of anti-depressants called seratonin re-uptake inhibitors (SRIs), originally introduced as mood-altering drugs which were more effective and safer than the older, tricyclic anti-depressants. But many of the men who began to use them complained they were taking much longer to ejaculate. Doctors have now realised that this side-effect, while unfortunate for some, could be positively advantageous for others with difficult-to-treat PE.

"Clinical practice suggests these drugs are very effective at delaying ejaculation," says Dr Alan Riley, senior lecturer and consultant in human sexuality at St George's Hospital Medical School in London. "I normally prescribe them for three or four months, starting with the lowest possible dose and increasing it until the patient gets ejaculatory control."

Ideally, Dr Riley still prefers behavioural therapy. "I use drugs where that hasn't worked or where I feel it won't work." After a period of regular drug use, Dr Riley advises his patients to take a tablet when they feel they need it. "Taken at least two hours before making love, even a single dose can have the necessary pharmacological effect. The only problem is that it can put pressure on the couple; once he's taken his tablet, they may feel they have to do something about it."

However, use of anti-depressants for PE remains controversial. Alison Cobb, from the mental health charity Mind, points out that they are associated with side-effects which include nausea, abdominal pain, nervousness and insomnia. "It's certainly a matter of concern if a drug intended for one purpose - to treat depression - is being used specifically for one of its adverse side-effects."

Since SRIs are not licensed for the treatment of premature ejaculation, the doctor who prescribes them, not the manufacturer, is held responsible for side-effects. Dr Lynne Webster, consultant psychiatrist at Manchester Royal Infirmary, takes the view that SRIs are safe and effective drugs for premature ejaculation. "People taking these drugs are unlikely to run across major problems," she says.

"The fact that they are anti-depressants is irrelevant and incidental; if an anti-hypertensive or an anti-epileptic drug had the same side-effect, we'd be using that. But there are some patients depressed because of their PE and, for them, there's an additional logic for using SRI drugs."

Alan Riley says: "Drugs should never be seen as a panacea for sexual problems. But PE should be taken seriously and the availability of these drugs may mean more patients will now come and seek treatment."