These SSRIs work by affecting the central nervous system and delaying the triggering mechanism for ejaculation. Dosage of the SSRI coincided with ejaculation delays until the tipping point, when men couldn’t ejaculate. That is the downside of this drug so a patient and doctor need to have a frank discussion of patient expectations and possible side effects.

SSRIs, TCAs and Migraines

These two classes of antidepressants, SSRIs and TCAs, may both be useful for migraine patients who cannot tolerate the standard protocol. These drugs are also good if the patient has concomitant depression or anxiety or any other illness that is responsive to antidepressants. Preliminary studies with fluoxetine, an SSRI, saw a significant decrease in migraines but it is too early in the research process for conclusions.

A TCA known as amitriptyline was deemed one of the most effective medications for migraines. Seventy percent of patients prescribed amitriptyline found acceptable relief, especially if the headache was a tension and migraine headache simultaneously. This drug affects the levels of serotonin and other chemicals in the brain. There is one SNRI, Effexor, that may be helpful in preventing migraines but further studies must be done.

Vasovagal Syncope

Just a fancy way of saying, “fainting.” This fainting is usually caused by standing up quickly, dropping blood pressure, leading to a brief decrease in blood flow to the brain. And fainting. But SSRIs may lower the activity level of the sympathetic nervous system in a way that doesn’t allow for lowered blood pressure in the body. Doctors recommend long-term use of SSRIs for those with frequent fainting spells. The mechanism is not well understood and needs further study.