Twenty-four men with paraphilias (PA; n = 13) and paraphilia-related disorders (PRD; n = 11) were consecutively treated with sertraline (mean dose, 100 mg/day; mean duration, 17.4 +/- 18.6 weeks). Baseline depression severity, total sexual outlet (TSO), and average time per day (ATD) spent in unconventional sexual behavior were obtained. At outcome, sertraline produced a statistically significant reduction in unconventional TSO and ATD in both PAs and PRDs without adversely affecting conventional TSO. This therapeutic effect was independent of baseline depression severity score. Clinically significant improvement was reported by approximately one-half of the men who complied with at least 4 weeks of sertraline pharmacotherapy. Nine men who failed to respond to sertraline were subsequently given fluoxetine. Fluoxetine (mean dose, 50 mg/day; mean duration, 30 weeks) produced a clinically significant effect in 6 additional men. Overall, 17 of the 24 men (70.8%) who received pharmacological treatment with sertraline and/or fluoxetine for at least 4 weeks sustained a clinically significant response, at times lasting more than 1 year. The evolving role of selective serotonin reuptake inhibitors for the amelioration of sexual impulse disorders is discussed.