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A variety of drugs have been reported as treatments of drug-induced delayed ejaculation [94 105] The drugs facilitate ejaculation by either a central dopaminergic or anti-serotonergic mechanism of action However, there are no published placebocontrolled studies and most reports are anecdotal case reports/series of men with anti-depressant or anti-psychotic drug induced IE

Buspirone is a 5-HTIA receptor agonist [111] Othmer et al reported normalization of sexual function in eight out of 10 men with a generalized anxiety disorder and associated sexual dysfunction, using a dose range of 15 to 60 mg daily [104]

that (regardless of locale) the man s running a fever and his response may not accurately correspond with the actual air temperature While this particular ambiguity is readily dispelled, the scenario draws attention to perhaps the greatest Macro Quantum challenge devising, gathering, and interpreting appropriate measurements and statistics Speci cally, what measures should we be using to judge wellbeing, success, wealth, progress, and happiness Temperature is fairly objective and easy to quantify, but measuring complex phenomena like economic advancement is messier and more subject to distortion than one might imagine How do we best collect and aggregate data How can we account for observational error and intentional statistical manipulation Can we compare gures across borders And is just measuring GDP alone enough to give us the best barometer for advancement While Adam Smith is often considered the father of modern economics, English economist and philosopher William Petty actually tried to get a scienti c handle on the country s economic health almost a century before Smith and made some of the rst estimates of national accounts (an accounting measure of the entire country s income and output) in 1665 Petty, Oliver Cromwell s chief economist and assistant to philosopher Thomas Hobbes, was one of the rst thinkers to note that a country s wealth was larger than its sum of gold and silver In trying to estimate the size of Britain s economy, he discovered that England s stock market was worth more than all its hard assets land, metals, and livestock and the difference must be the value of people human capital3 Petty was one of the rst to recognize money in circulation and the velocity of it changing hands had much to do with economic value It was here that the basic notion of analyzing and quantifying a country s economic activity was born The next major breakthrough in national accounting didn t come until the early twentieth century, as Ted Halstead and his colleagues describe: In 1931 a group of government and private experts were summoned to a congressional hearing to answer basic questions about the economy It turned out they couldn t; the most recent data were for 1929, and they were rudimentary at that In 1932, the last year of the Hoover administration, the Senate asked the Commerce Department to prepare comprehensive.

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Cyproheptadine, a serotonin (5-HT) receptor antagonist has been shown to increase male sexual activity in the rat [106] Several anecdotal case reports and small case series mention success of the use of cyproheptadine to reverse the anorgasmia induced by the SSRI antidepressants However, controlled studies have not been published [94,97,98] The case reports suggest an effective dose range of 2 to16 mg, administration on a chronic or ondemand basis

Figure 415 Tree-authenticated one-way chain (to authenticate a routing update with sequence number 1, metric 1, the shaded values have to be used)

Bupropion is a dopamine reuptake inhibitor [112] Ashton and Rosen described reversal of SSRIinduced anorgasmia in 66% of patients studied [105]

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Inhibited ejaculation has been less well researched than PE, probably because fewer cases are seen The etiology of inhibited ejaculation is multifactorial and includes organic and psychologic distur-bances; pharmacologic agents are also implicated Improved techniques for clinical evaluation are required Except where a treatable organic cause has been identi ed or a drug known to impair ejaculatory function has been withdrawn, the mainstay of treatment is by psychotherapy, but this is not evidencebased, as the most successful psychotherapeutic intervention has not been established Future research should address this shortcoming A number of pharmacologic agents are reported to treat drug-induced delayed (inhibited) ejaculation, but these observations are not based on well-controlled and adequately powered studies, but rather on single cases or small series of cases The pharmacotherapy of inhibited ejaculation requires proper evaluation

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