Sertraline vs Fluoxetine

Zoloft vs Prozac — which drug delivers the best results?


What are the strengths and weaknesses of sertraline and fluoxetine?

Sertraline and fluoxetine both are prescription antidepressants of the SSRI class (selective serotonin reuptake inhibitor). Both medications are available as generic versions, but the most popular trade names are Zoloft (Pfizer) for sertraline and Prozac (Eli Lilly & Co) for fluoxetine. 

SSRIs increase serotonin levels in the brain, which improves the mood and stabilizes overall mental wellbeing of people suffering from depression, panic disorder, and other psychological conditions. Since SSRIs broadly affect chemical messaging between brain cells, they also have an effect on libido and sexual sensitivity. In fact, a common side effect of these antidepressants is that for some people they decrease sexual appetite and cause orgasm difficulties.

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However, this “side effect” works great for men who have problems with ejaculating too early. Given how common this problem is — 20-30 percent of men experience premature ejaculation at some point in their lives — SSRIs were first studied as a potential treatment for premature ejaculation in 1994. 


Following over two decades of research, the verdict is clear: SSRIs significantly delay ejaculation and thus make sex more enjoyable for many men and their partners. In fact, SSRIs are considered the most effective pharmaceutical treatment for premature ejaculation. They can delay ejaculation timing from half a minute to 5-6 minutes or even longer. While the U.S.FDA so far hasn’t approved any SSRIs specifically for treating premature ejaculation, the American Urologic Association since 2004 recommends sertraline and other SSRIs for this purpose.


Even though their chemical design and function are very similar, the delaying impact on ejaculation varies between different SSRIs. Many studies show that paroxetine (also known as Paxil) and sertraline are the most effective choices and outperform fluoxetine. By how far sertraline outperforms fluoxetine is a question not yet fully settled, but it may delay ejaculation by 10 to 30 percent longer than fluoxetine. 


As for potential side effects, there’s no big difference between the two drugs or other major SSRI, especially as they are taken in low doses when treating premature ejaculation. Commonly observed side effects of low-dosage use are diarrhea, nausea, and mood changes. The intensity of these side effects tends to be mild to moderate. There are some minor differences between sertraline and fluoxetine: the former is somewhat more likely to cause diarrhea, while fluoxetine is more prone to causing sleep problems and a dry mouth. Talk to a doctor to learn more about the whole range of possible SSRIs side effects.


So, what’s the bottom line: sertraline or fluoxetine? Research is in favor of sertraline and you can expect it to deliver better results. If your doctor agrees, you actually could try both, each for a couple of months, for example, to see which drug in your specific case strikes the best balance between effectiveness and side effects. 


How are sertraline and fluoxetine taken for treating premature ejaculation?

In most clinical trials that test the effectiveness of sertraline, fluoxetine and other SSRIs for delaying ejaculation participating men were put on a low daily dose of the drug for one or several months. This approach definitely works but may not be necessary; at least not initially. 

Taking sertraline or fluoxetine on an ad-hoc basis — a one-off pill taken 4-8 hours prior to sexual activity — has been shown to produce similar results than the daily regimen and significantly lowers the risk of developing side effects. Used on such an as-needed basis, a one-off of 50-100mg of sertraline or 20-40mg of fluoxetine are considered normal doses. 


If pre-sex ad-hoc use doesn’t deliver desired results, you may start considering a low daily dose. Discuss with your doctor which treatment approach may work best for you.   


Can I take sertraline and fluoxetine together? 

Taking both drugs simultaneously isn’t advisable. There’s an increased risk of getting an irregular heartbeat which in very rare cases can be fatal. Moreover, taking both sertraline and fluoxetine together doesn’t provide any additional benefits for delaying ejaculation. Both drugs function in similar ways and trigger the same reaction in body and mind. Using either one of them will be enough.  



  1. Zhang, Dong, et al. “Paroxetine in the Treatment of Premature Ejaculation: A Systematic Review and Meta-Analysis.” BMC Urology, vol. 19, no. 1, 3 Jan. 2019, Accessed 15 Dec. 2019.
  2. McMahon, ChrisG. “Premature Ejaculation.” Indian Journal of Urology, vol. 23, no. 2, 2007, p. 97,, Accessed 15 Dec. 2019.
  3. Arafa, Mohamed, and Rany Shamloul. “A Randomized Study Examining the Effect of 3 SSRI on Premature Ejaculation Using a Validated Questionnaire.” Therapeutics and Clinical Risk Management, vol. 3, no. 4, 2007, pp. 527–31, Accessed 15 Dec. 2019.

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