Imipramine Ejaculatory dysfunction treated with * bethanechol: first report

A 37-year-old man with a history of recurrent major depressive episodes receiving treatment with trifluoperazine 5mg at night, benzatropine 2mg bid and trazodone 250mg at night complained of ejaculation failure and prolonged erections lasting 30 min after stopping sexual activity. Because of the possibility that erections were prodromal to priapism, trazodone was replaced, initially with desipramine, and then with imipramine 250 mgjday when generalised urticaria developed. Prolonged erections subsided but ejaculatory failure was persistent and did not resolve with withdrawal of trifluoperazine and benzatropine.

Bethanechol 10mg taken 30 min before sexual activity was found to restore the ejaculatory response. This regimen has been continued for 6 months and attempts to withdraw bethanechol have been consistently associated with a return of ejaculatory dysfunction.

This was believed to be ' ... the first report of the reversal of Imipramine­induced anorgasmia with bethanechol'.

Segraves RT American Journal of Psychiatry 144 1243-1244. Sep 1987

0157-7271/87/1017-0007/0$01.00/0 © ADIS Press REACTIONS' 17 October 1987 7