Psychopharmacology, 08 November 2022
Changes of insular function in lifelong premature ejaculation patients before and after SSRI administration
Ming Gao, Bowen Geng, Shuming Zhang, Ke Xu, Pengyu Li, Duoli Chen, Xiao Zeng, Peng Liu & Yanzhu Wang
Abstract
Objective
Lifelong premature ejaculation (PE) is regarded as one of the most common male sexual dysfunction. We aimed to detect whether insula-related brain functional networks are altered in lifelong PE patients and whether such alterations are “normalised” after selective serotonin reuptake inhibitors (SSRI) administration.
Methods
Twenty-three drug-naive lifelong PE patients and 30 healthy controls (HC) were recruited in current study. All subjects underwent resting-state functional magnetic resonance imaging (fMRI) scan at first. One hour after dapoxetine administration, all patients underwent fMRI scanning again. The degree centrality (DC), amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo) analysis, and ROI-based functional connectivity (FC) analysis were applied to calculate the abnormalities in insula-related functions among three groups.
Results
Compared to HC group, PE patients at baseline showed significantly altered DC, ALFF, and ReHo value of the bilateral insula, which subsequently showed a “normalised” trend after dapoxetine administration. Additionally, compared to HC group, PE patients at baseline showed significantly decreased FC between insula and precentral gyrus, inferior frontal gyrus, middle/inferior temporal gyrus, and caudate, while patients after dapoxetine administration showed increased insula-related FC in anterior cingulate cortex and decreased FC in thalamus and middle/inferior temporal gyrus. The main effects of dapoxetine were located in precentral gyrus, inferior frontal gyrus, caudate, and limbic system.
Conclusions
Our findings report altered brain mechanism of insula in lifelong PE patients and also indicate that dapoxetine can “normalise” the abnormal function of the insula to certain extent in lifelong PE patients.
https://link.springer.com/article/10.10 ... 22-06268-5
I'm wondering is the effect of ssri direct on the insula or is it an indirect effect? to give an example, if ssri reduces genital peripheral sensitivity this may cause the insula to eventually respond more or less intensely?
most authors believe that the effect of delayed orgasm caused by SRIs is due to direct effects on the brain, as neuroimaging shows that before and after SRI areas are activated differently in conjunction with a prolonged time to orgasm. But there is also the possibility that they are just a consequence of more direct effects on the peripheral nervous system, namely genital hypoesthesia that may involve ion channels in nerve endings, as Waldinger's 2014 study suggests (https://pubmed.ncbi.nlm.nih.gov/25483212/) (let us remember that Waldinger is no longer in this world).
this a survey from a few months ago in a subreddit on premature ejaculation, "serotonin in the brain or reduced genital sensitivity?":
https://www.reddit.com/r/PrematureEjacu ... premature/
Changes of insular function in lifelong premature ejaculation patients before and after SSRI administration. 2022
Re: Changes of insular function in lifelong premature ejaculation patients before and after SSRI administration. 2022
This could be very interesting. Funny how they can do studies like this when it comes to premature ejaculation.
Re: Changes of insular function in lifelong premature ejaculation patients before and after SSRI administration. 2022
Nice find.anacleta wrote: ↑Sat Nov 12, 2022 6:48 am
I'm wondering is the effect of ssri direct on the insula or is it an indirect effect? to give an example, if ssri reduces genital peripheral sensitivity this may cause the insula to eventually respond more or less intensely?
most authors believe that the effect of delayed orgasm caused by SRIs is due to direct effects on the brain, as neuroimaging shows that before and after SRI areas are activated differently in conjunction with a prolonged time to orgasm. But there is also the possibility that they are just a consequence of more direct effects on the peripheral nervous system, namely genital hypoesthesia that may involve ion channels in nerve endings, as Waldinger's 2014 study suggests (https://pubmed.ncbi.nlm.nih.gov/25483212/) (let us remember that Waldinger is no longer in this world).
this a survey from a few months ago in a subreddit on premature ejaculation, "serotonin in the brain or reduced genital sensitivity?":
https://www.reddit.com/r/PrematureEjacu ... premature/
Could be direct or indirect effect in once. SERT is expressed in Insular cortex but also in the somatosensory cortex - both regions process sensory information.
If the effect is immediate you can presume it's from direct serotonin action on neural networks. Not anything hormone / protein / epigenetic related.
Such studies are the best. Not poisoned by psychiatry POV or biases.
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