When it comes to comprehensive treatment plans for mood disorders such as Depression and anxiety, selective serotonin reuptake inhibitors (SSRIs) have long been considered a frontline treatment strategy. While antidepressants such as SSRIs can sometimes play a pivotal role in a patient’s mental health regimen, the widespread use of such medications has sparked both curiosity and concern regarding their potential effects on fertility. Contemporary clinical research investigating semen quality poses the question, “Do SSRIs affect fertility?”
Understanding the Effects of SSRIs
SSRIs work to regulate and elevate mood by selectively inhibiting the reuptake of serotonin in the brain, thereby prolonging and increasing the presence of serotonin in the synaptic clefts between neurons. Alongside anxiety and Depression, SSRIs are often prescribed to treat obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), chronic pain, and panic disorder.
While SSRIs are well-lauded for their benefits, they are also highly scrutinized because of their wide range of side effects. Common side effects of SSRIs include feelings of agitation, nausea, headaches, sedation, weight gain, erectile dysfunction, and diminished libido. Researchers concur that “all classes of antidepressants are known to be associated with some degree of sexual dysfunction in both men and women,” with SSRIs causing sexual dysfunction in 25–73% of patients.
While the aforementioned effects are well-documented, relatively little is known about the interplay between SSRIs and semen quality or male fertility. With the use of antidepressants ever on the rise, and global semen quality and male fertility significantly decreasing over the past four decades, interrogating the long-term correlation between the two (if any) will prove of clinical importance in the years to come.
Do SSRIs Affect Fertility? Reviewing the Clinical Data
So, do SSRIs affect fertility, specifically the quality of male semen? In 2022, researchers published a systematic review in the journal Frontiers in Pharmacology that investigated semen quality in 222 male participants. After conducting a systematic search and screening in PubMed and Embase, four qualifying studies (published between 2008 and 2015) were selected for review and analysis.
Collectively, these studies explored the effects of daily administered SSRIs on semen parameters before and after continuous treatment for Depression or premature ejaculation. These parameters included semen volume and sperm morphology, motility, concentration and the sperm DNA fragmentation index (DFI).
First, researchers concluded that SSRIs significantly reduced normal morphology, with a subgroup analysis suggesting that morphology was further reduced after three months of use as opposed to one month of SSRI treatment. In addition, after three months, “sperm concentration in the experimental group was significantly lower than that in the control group.” Sperm motility was similarly impacted after three months of treatment. DFI was also significantly higher among those taking SSRIs as opposed to the control group, suggesting that SSRIs also affect sperm’s DNA integrity. As for semen volume, SSRIs had no clinically significant impact.
Overall, this study concluded that “SSRIs have a statistically significant impairment on semen quality,” with more research needed to account for periods of spermatogenesis and additional factors implicated in semen heterogeneity, such as genetics, comorbidities, and environmental factors.
An additional study examining the effects of antidepressants on semen parameters and male fertility was published by the International Journal of Urology in 2019. Researchers reviewed available data concerning both human and animal semen and fertility after taking SSRIs including fluoxetine, fluvoxamine, sertraline, citalopram, paroxetine, and escitalopram. The studies they analyzed all exhibited a decline in semen quality and increased DNA fragmentation rates with the usage of SSRIs, affirming the urgent need for further research assessing the gonadotoxic effects of antidepressants.
It’s important to note that both of the aforementioned studies indicated that their data supported the possibility of returning semen quality to baseline following the discontinuation of SSRI treatment, with the duration of recovery in male patients measuring around 73 days or 3 months, positing that this is because SSRIs disrupt spermatogenesis. This analysis proves hopeful for individuals who are concerned about their fertility and may be considering de-escalating their antidepressants in service of alternative treatment mechanisms.
Concerned About Infertility? Mid City TMS Offers Alternatives
After interrogating the question “Do SSRIs affect fertility?” the clinical conclusions and implications can be rather unsettling for both men and women—especially for those hoping to start a family in the near future.
With over 30 years of experience in treating patients with Depression, anxiety, and other mood disorders, the clinicians of Mid City TMS know firsthand just how stressful some of these side effects can be. That’s why we’ve devoted our clinical practice to providing effective, low-risk treatment alternatives, such as transcranial magnetic stimulation (TMS) and esketamine therapy. These safe, non-invasive treatments are highly effective—and have no reported effects on fertility.
Contact us today to learn more about how our offerings can help you nurture your mental health back to baseline—without the added risk.