LEPTIN LEVELS IN TREATING PREMATURE EJACULATIONM. ATMACA Serum leptin levels in patients with premature ejaculation
before and after citalopram treatment

M. ATMACA, M. KULOGLU, E. TEZCAN, B. USTUNDAG* and A. SEMERCIOZ†Departments of Psychiatry, *Clinical Biochemistry and †Urology, Firat University, School of Medicine, Elazig, Turkey OBJECTIVE
serotonergic systems. In a previous study between the groups at baseline; it increased serum leptin levels were high in patients with after 8 weeks of treatment with citalopram in To evaluate serum leptin levels (an adipocyte premature ejaculation. The present study group I, to a mean (SD) of 209 (72.1) s, but not in group II. No difference was detected in ejaculation according to the Diagnostic and leptin levels between the groups at baseline, ejaculation before and after treatment with Statistical Manual of Mental Disorders Third but at 8 weeks they were lower in group I.
citalopram, a selective serotonin reuptake Revised Version. Fifteen patients (group I) inhibitor, with the hypothesis that leptin CONCLUSION
citalopram treatment and the remainder (15, group II) received no therapy. The patients As hypothesized, leptin levels decreased in patients with premature ejaculation after PATIENTS AND METHODS
intravaginal ejaculation latency time, and treatment with citalopram, and this decrease seemed to be linked to the therapeutic effect. The inhibitory effect of serotonin on libido, measured at baseline and after 8 weeks.
Further experimental studies are needed.
ejaculation and orgasm is well documented. Although there is no direct evidence of an KEYWORDS
association involving brain pathways which are related to sexual behaviour, there is an There was no significant difference in the leptin, premature ejaculation, serotonin, mean intravaginal ejaculation latency time INTRODUCTION
drugs is the enhancement of net serotonergic leptin levels might become normal during this transmission by blocking the presynaptic 5- hydroxytryptamine uptake site [7]. Leptin is a as uncontrolled ejaculation, the essential fat-cell-derived hormone which signals the feature of which is recurrent or persistent PATIENTS AND METHODS
regulation of weight and sexual behaviour, and so it is thought to lead to suppression of The study comprised 30 married men (aged appetite, weight loss and acceleration of sexual maturation, and to stimulate energy institution, and had been diagnosed with expenditure [8,9]. Zhang et al. [10] reported masturbation for considerably longer than that it is a product of the ob gene. The Diagnostic and Statistical Manual of Mental Disorders Third Revised Version (DSM-III-R) psychiatric disorders has been noted [11–14]; [17] and met the study admission criteria. The The inhibitory effect of serotonin on libido, moreover, there is an interaction between the ejaculation and orgasm is well documented, leptinergic and serotonergic systems in the groups on a double-blind basis, determined by CNS [15] and leptin has no significant effect patients (group I) received citalopram for neurotransmitter enhancing sexual function) while leptin perfusion induces a significant increase in 5-hydroxy indole acetic acid therapy (behavioural or pharmacological).
metamphetamine (better known as ecstasy) overflow from the hypothalamus [15,16]. In induces serotonin and dopamine release with Each patient was evaluated diagnostically in a central action, and causes an increase in significantly high serum leptin levels in detail by one trained psychiatrist using the libido and sexual satisfaction by dopamine patients with premature ejaculation, after Structured Clinical Interview for DSM-III-R release, while causing delay and prominent adjusting for body mass index or age. These outpatient form [18]. Patients with any kind serotonin activation [4]. Selective serotonin whether there would be a change in serum excluded. To be able to exclude organic sexual reuptake inhibitors (SSRIs) are reported to be leptin levels in patients with premature dysfunctions, fasting glucose level, urine effective for treating premature ejaculation ejaculation before and after treatment with analysis, complete blood count, sex hormones citalopram, an SSRI, and we hypothesized that 2 0 0 3 B J U I N T E R N A T I O N A L | 9 1 , 2 5 2 – 2 5 4 | doi:10.1046/j.1464-4096.2003.04052.x L E P T I N L E V E L S I N T R E A T I N G P R E M A T U R E E J A C U L A T I O N between leptin levels and the duration of the condition, at baseline, in both groups (r = 0.61 and 0.56 for groups I and II, respectively).
Citalopram was well-tolerated; there were 14 reports of adverse effects from eight patients, the most frequent being gastrointestinal complaints (four) and insomnia (three). No patient withdrew from the study because of DISCUSSION
The major findings of the present study are that citalopram treatment considerably patients were free of all medication for at least the previous 2 weeks. Patients were of < 25 kg/m2. Serum leptin levels were positive correlation between leptin levels and excluded if: they had erectile dysfunction and assayed at baseline and after treatment with the duration of the condition. SSRIs have been inhibited male orgasm, a severe physical illness, a history of alcohol and substance premature ejaculation [5,6]. In the present abuse or dependence, a previous history of The statistical analysis used independent- study, citalopram, the most selective SSRI sample and paired t-tests, analysis of [19], produced considerable improvements in endocrinological state. All participants were covariance (ANCOVA) and Pearson's method of patients with premature ejaculation, even correlation, with differences considered though the study had methodological limits, significant at P <0.05 for all tests.
e.g. relatively few patients. The effect of All patients were carefully assessed to exclude serotonin on premature ejaculation and other autoimmune, pulmonary, infectious diseases sexual dysfunction was hypothesized from and neoplasms. Their body mass index (BMI) was calculated. They were asked to determine the average intravaginal ejaculation latency The characteristics of the two groups are time (IELT) for three consecutive episodes of inhibition of antidepressant-induced orgasm coitus, verified by both patients and their could be reversed by a nonselective serotonin wives, using a chronometer. The IELT was significantly after treatment with citalopram. No patient had a significant weight change on Fluoxetine, an SSRI, has been reported to intromission and ejaculation. The patients and citalopram; while one lost 0.6 kg and one reduce the plasma leptin levels in rats [22], their wives were encouraged to have coitus at 0.4 kg, three gained weight of 0.8, 0.6 and which was supported by the present study least twice per week. Patients in group I using a different SSRI (citalopram); leptin initially received 20 mg/day citalopram for administration also stimulated serotonin 1 week; this was titrated up to 60 mg/day At baseline, the leptin levels were high in nine turnover [23]. In contrast, in another study according to the patient's tolerability and patients in group I and in eight in group II, clinical response. In addition, they were asked administration of fluvoxamine (an SSRI) and to report adverse effects using an instrument designed by the authors which included all significant difference in serum leptin levels influenced immunomodulation by clozapine side-effects reported that were related to between the groups at baseline, adjusted for and some of its side-effects, the two together antidepressant use. Thus, side-effects were BMI (ANCOVA). At 8 weeks the mean leptin level enhanced the clozapine-induced increase in recorded as ‘present’ and ‘absent’. After was significantly lower than baseline (ANCOVA leptin plasma levels with no significant effect describing the study to the patients, written with BMI as the covariate, P < 0.05, adjusted for BMI) in group I (P < 0.001), but not in Hastings et al. [16] investigated the and ethical permission obtained from the local ethics committee of Firat University neurotransmitter systems of the rat brain, There was a positive correlation between reporting that leptin had no significant effect To determine the serum levels of leptin, all the baseline (r = 0.62 and 0.56, P < 0.05 for while leptin perfusion induced a significant groups I and II, respectively) and at 8 weeks increase in 5-hydroxy indole acetic acid samples were drawn from an antecubital vein (r = 0.58 and 0.54, both P < 0.05). Correlation at 08.00 hours and leptin levels measured analysis between leptin levels and age showed using a radioimmunoassay kit (rat leptin kit, no statistical significance in both groups correlation between leptin levels and the Linco Corp., St Charles, MO, USA) in a gamma (respectively at baseline and 8 weeks, r = 0.08 duration of illness or the IELT; this suggest counter (LKB Wallac 1261, Wallac Corp., Turku, and 0.06 for group I, and 0.17 and 0.12 for that an increased severity of illness affects Finland). Normal values are <10 for males and group II). There was also a positive correlation leptin levels, and that as the illness becomes 2 0 0 3 B J U I N T E R N A T I O N A L Yilmaz Y. The efficacy of fluoxetine in the brain in vitro. Regul Pept 2002; 103: 67–
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