Lexapro, known generically as escitalopram, is a selective serotonin reuptake inhibitor (SSRI) primarily approved for treating major depressive disorder and generalized anxiety disorder. Premature ejaculation (PE) is a common male sexual dysfunction characterized by ejaculation occurring sooner than desired. The use of escitalopram for PE is considered an off-label application, meaning it is not specifically approved by the Food and Drug Administration (FDA) for this purpose. This application arose because delayed ejaculation is a known side effect of SSRIs, which healthcare providers have adapted to treat PE.
The Pharmacological Basis for Delaying Ejaculation
The ability of SSRIs like escitalopram to delay ejaculation stems from their effect on the central nervous system’s control of the ejaculatory reflex arc. Ejaculation is a complex process mediated by neurotransmitters, and serotonin (5-HT) plays a significant role, acting as an inhibitory signal that modulates the spinal cord pathways responsible for the ejaculatory reflex.
Escitalopram works by blocking the reuptake of serotonin back into the presynaptic neuron. This inhibition increases the concentration of serotonin within the synaptic cleft, prolonging its effect. The resulting enhanced serotonergic neurotransmission activates specific serotonin receptors, particularly the 5-HT2C receptor, which is thought to raise the ejaculatory threshold. By elevating this threshold, the nervous system requires a greater level of stimulation to trigger the reflex, thereby delaying ejaculation.
Typical Dosing and Expected Results
Healthcare providers typically prescribe escitalopram for premature ejaculation at a low-dose regimen, which is often lower than the doses used for anxiety or depression. A common dosage used in clinical studies is 10 milligrams per day, though the specific dose is determined by a physician. The medication is usually taken daily rather than on-demand, because SSRIs generally require a period of consistent use to build up in the system and achieve their full therapeutic effect.
Daily dosing is preferred over on-demand use for PE because it maintains a stable, elevated level of serotonin in the central nervous system. Clinical data indicates that the full efficacy for delaying ejaculation may not be observed until several weeks into treatment. Studies measuring Intravaginal Ejaculatory Latency Time (IELT) have shown substantial improvement after four weeks of daily use.
Specific Side Effects and Safety Considerations
While the delayed ejaculation effect is beneficial for treating PE, escitalopram can cause other adverse effects. Common side effects associated with SSRI use include drowsiness, nausea, fatigue, and insomnia, which frequently diminish after the first few weeks of treatment. Of particular concern are sexual side effects other than delayed ejaculation.
These adverse effects include decreased libido and difficulty achieving orgasm (anorgasmia). Some men may also experience issues with erectile function. Abruptly stopping escitalpram can lead to a discontinuation syndrome, involving symptoms like dizziness, sensory disturbances, and mood changes, so the medication must be tapered down under medical supervision.
Other Medical Options for Premature Ejaculation
Lexapro is one of several pharmacological options for treating premature ejaculation, including other SSRIs frequently prescribed off-label. These alternatives include fluoxetine (Prozac), sertraline (Zoloft), and paroxetine (Paxil), all of which operate through the same mechanism of increasing synaptic serotonin. Dapoxetine is another SSRI specifically formulated for on-demand use and is approved in many countries for PE, though it is not currently available in the United States.
Paroxetine is often cited as being one of the most effective daily-use SSRIs at prolonging IELT. Beyond oral medications, topical anesthetic creams and sprays offer a non-systemic treatment option. These products contain numbing agents like lidocaine or prilocaine, which are applied directly to the penis before intercourse to reduce sensitivity and delay the ejaculatory response. Behavioral techniques, such as the start-stop method or the squeeze technique, are foundational non-pharmacological approaches that can be used alone or combined with medication.