The British Journal of Psychiatry (2000) 177: 282-283
© 2000
The Royal College of
Psychiatrists
Venlafaxine-induced painful ejaculation
A.
Michael
Department of Psychiatry, West Suffolk Hospital, Bury St
Edmunds IP33 2QZ
EDITED BY MATTHEW HOTOPF
Antidepressant drugs cause a variety of sexual side-effects.
Painful ejaculation is a rarely reported side-effect of
antidepressants, especially the newer drugs.
A 59-year-old man with recurrent depression had normal sexual
function while euthymic and mild decrease in libido while depressed.
Although his previous episode of depression responded well to
fluoxetine he was not keen on trying it again because of
fluoxetine-associated diarrhoea. During a depressive relapse he
was treated with venlafaxine 75 mg daily which was later increased to
150 mg daily. The antidepressant response was good. Unfortunately, he
developed painful ejaculation. It was sharp and burning
in nature and located deep in the shaft of the penis. It would begin
just before ejaculation and lasted until the penis
became flaccid. This was so unpleasant that it not only interfered
with the pleasure of intercourse, but also led him to avoid sexual
intercourse. The pain persisted despite reducing the dose of
venlafaxine to 75 mg. When venlafaxine was stopped the pain
disappeared. Later, he made a good recovery on citalopram 40 mg
daily. He denied experiencing pain or any other sexual side-effects
and also denied having ever previously experienced painful ejaculation.
This is the first report of venlafaxine-induced painful ejaculation. Painful ejaculation/orgasm have been reported with various
tricyclic antidepressants (Kulik
& Wilbur, 1982; Aizenberg
et al, 1991). Some of the people in question improved with
dosage reduction or after changing to other tricyclics, but
others improved only when they stopped the medication. Hsu & Shen
(1995)
reported a case of fluoxetine-induced painful ejaculation that improved when the
dosage was reduced from 20 mg daily to 20 mg on alternate days. Thus,
painful ejaculation, when it occurs, could be a
dose-dependent side-effect in some individuals. It has been suggested
that partial blockade of peripheral sympathetic adrenergic receptors
could interfere with coordinated contractions of smooth muscles
involved in semen transport and thus induce painful spasms or retrograde ejaculation (Kulik
& Wilbur, 1982). However, venlafaxine has little if any
adrenoceptor-blocking action. Thus, the mechanism of antidepressant
drug-induced painful ejaculation remains elusive.
Sexual side-effects of antidepressant drugs cause distress, strain
relationships, impair quality of life and reduce compliance with
treatment. Enquiring routinely about side-effects, especially sexual
side-effects, of antidepressants would help to improve compliance
with treatment.
REFERENCES
Aizenberg, D., Zemishlany, Z., Hermesh, H.,
et al (1991) Painful ejaculation associated with antidepressants in
four patients. Journal of Clinical Psychiatry, 52, 461-463.[Medline]
Hsu, J. H. & Shen, W. S. (1995) Male
sexual side effects associated with antidepressants: A descriptive clinical
study of 32 patients. International Journal of Psychiatry in Medicine,
25, 191-201.[Medline]
Kulik, F. A. & Wilbur, R. (1982)
Case report of painful ejaculation as a side effect of amoxapine.
American Journal of Psychiatry, 139, 234-235.[Medline]
