SSRIs and the Daily Option
Only one oral medicine is licensed in the UK for this. Everything else is prescribed off-licence — which is legal and evidence-based, but changes who prescribes it and how.
Part of the Complete Premature Ejaculation Guide.
Key fact: Only one oral medicine is licensed in the UK specifically for premature ejaculation — dapoxetine. One topical treatment, the lidocaine/prilocaine spray Fortacin, is licensed too. Every other medicine used for it — including the daily antidepressants a GP may suggest — is prescribed off-licence, which is legal, common and evidence-based, but changes who can prescribe it and how it is monitored.
Why antidepressants at all
It looks like an odd choice until you know the mechanism. Serotonin has an inhibitory effect on the ejaculatory reflex — more serotonin activity in the relevant pathways means a longer time to ejaculation. Selective serotonin reuptake inhibitors raise serotonin activity, and delayed ejaculation is one of their most consistent and well-documented side effects.
That side effect is unwelcome when the drug is being used for depression. Used deliberately, it is the entire point. Men taking an SSRI for depression frequently report the delay before anyone connects it to the treatment of this condition.
The distinction that matters: using an SSRI for premature ejaculation is not treating a mental health problem. It is using a known pharmacological effect for a physical purpose, at doses and schedules chosen for that purpose. It does not imply that anxiety or depression is the cause.
Licensed and off-licence
Dapoxetine is the only oral medicine licensed in the UK specifically for premature ejaculation. It is a short-acting SSRI designed to be taken before sex rather than daily, and because it holds that licence it is the option available through an online pharmacy consultation.
One topical treatment is also licensed for the condition — Fortacin, a lidocaine/prilocaine spray applied to the glans shortly before sex. It is not an SSRI and works by reducing sensitivity rather than acting on the ejaculatory reflex centrally, so it sits outside the scope of this guide. Topical anaesthetics for premature ejaculation covers that route.
Other SSRIs — the ones normally prescribed for depression and anxiety — are used for premature ejaculation off-licence. That means the manufacturer has not sought a licence for this use, not that the use is improper.
| Licensed (dapoxetine) | Off-licence (other SSRIs) | |
|---|---|---|
| Evidence base | Trials conducted specifically for this use | Substantial evidence, and recognised in international guidance, but not submitted for a licence |
| Who prescribes | Available via online consultation from a registered pharmacy | A GP or specialist who knows your full history |
| Taken | A few hours before sex, as needed | Every day, continuously |
| Onset of benefit | From the first dose | Builds over one to two weeks |
| Legal position | Standard | Entirely legal — off-licence prescribing is routine across medicine |
| Responsibility | Shared with the licence holder | Sits more heavily with the prescriber, which is why the conversation is more detailed |
On-demand and daily
The practical difference between the two approaches is less about which drug and more about how life works.
On-demand
Taken before anticipated sex. Suits infrequent or unpredictable occasions, avoids continuous exposure to a medicine, and stops working as soon as you stop taking it. Requires some planning, which some couples find intrusive.
Daily
Taken every day regardless. Suits frequent or spontaneous sex, removes the planning entirely, and generally produces a greater delay. Means continuous medication, a build-up period, and side effects that are present all the time rather than occasionally.
Neither is better in the abstract. A man having sex twice a week with a regular partner and a man whose encounters are occasional and unplanned have genuinely different problems to solve.
Which ones are used
Several SSRIs have been studied for this. The ones most often used off-licence in UK practice are sertraline and paroxetine, with paroxetine generally producing the greatest delay in comparative studies and also being the most likely to cause discontinuation effects when stopped.
The choice between them is a clinical one and depends on your history, other medicines and what matters most to you — which is precisely why this sits with a GP rather than being self-selected. Doses used for this purpose are often at the lower end of the antidepressant range.
Clomipramine, an older tricyclic antidepressant, is also used off-licence and can be effective, but has a heavier side-effect profile. Tramadol has been studied and is generally avoided for this purpose in UK practice because of dependence risk. Neither should be sought without a clinician raising it first.
What taking one involves
- It takes time. A daily SSRI builds effect over one to two weeks, and judging it after a few days will mislead you in both directions.
- Early side effects often settle. Nausea, headache and tiredness in the first week or two commonly improve. Knowing that in advance is most of what gets people through it.
- Sexual side effects cut both ways. The delay is the intended effect; reduced libido or difficulty reaching orgasm at all are less welcome versions of the same mechanism, and are worth reporting rather than tolerating.
- Do not stop abruptly. SSRIs taken daily are reduced gradually. Stopping suddenly can produce dizziness, irritability and unpleasant electric-shock sensations — particularly with paroxetine.
- Alcohol interacts with the sedating effects, and heavy drinking works against you here anyway.
- Tell every prescriber you are taking it. SSRIs interact with a number of common medicines, including some painkillers and migraine treatments.
Who they are not suitable for
An SSRI is not appropriate without assessment if you take another antidepressant, lithium, triptans for migraine, tramadol, or St John's wort · have a history of bipolar disorder · have a bleeding disorder or take anticoagulants · have epilepsy · have significant liver or kidney disease · are under 18. Combining serotonergic medicines can cause serotonin syndrome, which is uncommon but serious — agitation, confusion, sweating, tremor, fast heart rate and fever after starting or increasing one require urgent medical attention.
There is also a specific point worth raising directly: if low mood or anxiety is present alongside the ejaculation problem, say so. It changes the choice of drug, the dose and the follow-up, and treating the mood properly sometimes improves the sexual symptom as a by-product.
How this is prescribed
Because daily SSRIs for this purpose are off-licence, they are prescribed by a GP or specialist rather than through an online consultation. That is not an obstacle so much as the correct route — it requires knowledge of your full medical history, other medicines and mental health, which a single-condition consultation does not capture.
- Book a routine GP appointment and say directly what it is about. It is a common consultation and they will have had it before.
- Say what you have already tried, for how long, and what happened.
- Mention any mood symptoms, alcohol intake and all medicines including anything bought online.
- Ask about the alternatives — behavioural approaches and psychosexual therapy are effective and are not a lesser option.
The licensed on-demand route, which does not require a GP appointment, is set out on our premature ejaculation treatment page. For many men that is the sensible first step, and the daily option is worth discussing if it is not enough or does not suit how they live. If an oral medicine is not what you want at all, a topical local anaesthetic such as Emla cream works by a different mechanism entirely — explained in our guide to Emla cream for premature ejaculation.
Frequently Asked Questions
Why would an antidepressant be used for premature ejaculation?
Because serotonin inhibits the ejaculatory reflex, so raising serotonin activity lengthens the time to ejaculation. Delayed ejaculation is one of the best-documented side effects of SSRIs — unwelcome when treating depression, and the entire point when treating this. Using one for premature ejaculation is not treating a mental health problem, and does not imply that anxiety or depression is the cause.
What does off-licence prescribing mean?
It means the medicine is being used for a purpose the manufacturer has not applied to have licensed. It is legal, routine across medicine, and in this case supported by substantial evidence and recognised in international guidance. The practical consequences are that it is prescribed by a GP or specialist who knows your full history rather than through a single-condition online consultation, and that the prescriber carries more of the responsibility, so the conversation is more detailed.
Is a daily tablet better than one taken before sex?
Neither is better in the abstract — they solve different problems. A daily medicine suits frequent or spontaneous sex, removes any planning and generally produces a greater delay, but means continuous medication, a one to two week build-up and side effects that are always present. An on-demand approach suits infrequent or unpredictable occasions and avoids continuous exposure, but needs some forethought. How often and how predictably you have sex is usually what decides it.
How long does a daily SSRI take to work for premature ejaculation?
Typically one to two weeks to build a meaningful effect, which is why judging it after a few days is unreliable. Early side effects such as nausea, headache and tiredness are common in the first week or two and frequently settle, so the point at which people are most likely to give up is often just before it starts working properly.
Can I just stop taking it when things improve?
Not abruptly. A daily SSRI should be reduced gradually under guidance, because stopping suddenly can cause dizziness, irritability and unpleasant electric-shock sensations — particularly with paroxetine. It is also worth knowing that the effect generally does not persist after stopping unless behavioural work has been done alongside, which is one reason combining medication with behavioural approaches produces more durable results.
References
- National Institute for Health and Care Excellence. Clinical Knowledge Summary: Ejaculatory dysfunction. cks.nice.org.uk
- NHS. Ejaculation problems. nhs.uk
- European Association of Urology. Guidelines on Sexual and Reproductive Health. uroweb.org
- International Society for Sexual Medicine. Definition and guidelines for premature ejaculation. issm.info
- Joint Formulary Committee. British National Formulary: dapoxetine and selective serotonin reuptake inhibitors. bnf.nice.org.uk
- British Association of Urological Surgeons. Patient information. baus.org.uk
Medical disclaimer: This article is for informational purposes only and does not constitute medical advice. Dapoxetine is the only oral medicine licensed in the UK specifically for premature ejaculation (the lidocaine/prilocaine spray Fortacin is licensed as a topical treatment); other antidepressants used for it are prescribed off-licence and require assessment by a clinician who knows your history. Never start, stop or change a prescribed antidepressant on your own. Always consult a qualified healthcare professional for diagnosis and treatment.