Rosh Psychiatry Board Practice Exam

Which medication is most likely the cause of delayed ejaculation in men?

1. Bupropion

2. Mirtazapine

3. Nortriptyline

4. Sertraline

The correct answer is: Sertraline

Delayed ejaculation is a known potential side effect of selective serotonin reuptake inhibitors (SSRIs), one of which is sertraline. SSRIs function by increasing the levels of serotonin in the synaptic cleft, which can lead to various sexual side effects, including delayed ejaculation. This is because elevated serotonin levels can inhibit pathways that facilitate ejaculation. In clinical practice, among the SSRIs, sertraline is frequently associated with such sexual dysfunction. The mechanism at play may involve both enhanced serotonin signaling and effects on other neurotransmitters involved in sexual function. Other medications listed, while they may have their unique side effects, do not have the same strong association with delayed ejaculation as sertraline. Bupropion, for instance, is often considered to have a lower incidence of sexual side effects and is sometimes used as an alternative to SSRIs when sexual dysfunction is a concern. Mirtazapine and nortriptyline are also less commonly implicated in this particular side effect, as mirtazapine tends to lead more towards sedation and weight gain, while nortriptyline, a tricyclic antidepressant, can have anticholinergic effects but is not primarily linked to delayed ejaculation like sertraline.