Abstract

• Despite decades of widespread use, the adverse effect profile of “selective” serotonin reuptake inhibitor (SSRI) antidepressants has still not been fully elucidated.
   
• Studies in male animals have shown delayed sexual development and reduced fertility.
   
• Three prospective cohort studies conducted in over one hundred patients exposed to an SSRI for periods ranging from 5 weeks to 24 months found altered semen parameters after as little as 3 months of exposure: reduced sperm concentration, reduced sperm motility, a higher percentage of abnormal spermatozoa, and increased levels of sperm DNA fragmentation.
   
• One clinical trial showed growth retardation in children considered depressed who were exposed to SSRIs. SSRIs may have endocrine disrupting properties.
   
• Dapoxetine is a short-acting serotonin reuptake inhibitor that is chemically related to fluoxetine and marketed in the European Union for men complaining of premature ejaculation. But the corresponding European summary of product characteristics does not mention any effects on fertility.
   
• In practice, based on the data available as of mid-2014, the effects of SSRI exposure on male fertility are unclear. However, it is a risk that should be taken into account and pointed out to male patients who would like to father a child or who are experiencing fertility problems.

©Prescrire 1 January 2015

"Semen abnormalities with SSRI antidepressants" Prescrire Int 2015; 24 (156): 16-17. (Pdf, subscribers only)