Among the side effects of serotonin reuptake inhibitors known as SSRIs, two studies have shown that low sperm counts and sperm immobility have been associated with these SSRIs and possibly other classes of antidepressants as well. Among the male population in the United States it is estimated that ten percent suffer from depression. As with any medication there is always the risk of side effects and the need to weigh the side effects with the symptoms of the conditions being treated or the consequences of allowing the condition to go untreated. Studies have shown that depression can cause cell death in the hippocampus region of the brain and the SSRIs have been known to reverse this damage. This is one of the benefits of the SSRIs including the quick acting relief from the symptoms of depression.
The side effects of serotonin reuptake inhibitors should be weighed against their benefits
These side effects of the SSRIs may be of little consequence when compared to the benefits that SSRIs offer…unless you are trying to start a family. Many SSRIs will often give the patient quick relief from the horrible symptoms of depression in weeks. Other side effects are ejaculatory dysfunction and decreased libido, low sperm count and mobility, anxiety, depression, sometimes suicidal ideations, and memory issues to mention a few. If you should experience any of these you should contact your doctor immediately, and if you are having suicidal thoughts, go immediately to the ER. Considering the benefits and negative side effects is important before starting any medication management.
If a man is suffering from depression, should he postpone taking the SSRIs until his wife conceives? This depends upon the severity of his depression and his overall fertility. The couple should probably check with a fertility specialist in order to make sure that they are able to promote the optimal circumstances for conception, especially if the couple has been unable to get pregnant while trying over a six month period of time. Maybe even a sperm count and mobility check from his family practice physician will suffice. If the male has a more moderate depression he may chose to start on the SSRI after conception. If the depression is quite severe, the couple may have to postpone getting pregnant for a while until the male is stable and can risk coming off the SSRI medication with minimal chances of relapse. This usually requires the patient to be stabilized for at least 12 months before attempting to come off the medication. There are other options available as well such as trying other antidepressants. Other classes of antidepressants such as the tricyclics or the MAOIs may be the medication of choice or at least the medication used until conception occurs. There are also other forms of treatment such as, psychotherapy, VNS, TMS, ECT that should have no effect either on his sperm count or his libido.
The side effects of serotonin reuptake inhibitors might not affect man’s fertility
It might also be reasonable to have a baseline sperm count done before antidepressant therapy begins and then have one done several months after the patient has been stabilized on the medication. Some studies have shown that the side effects of serotonin reuptake inhibitors will drop the sperm count down to levels below the ability to conceive and almost zero; however, this might not be the case, especially with a virile individual or a fertile female. The recent study at the Cornell Medical Center tested two gentlemen of which each encountered fertility problems when put on an SSRI. The good news of the study was that this reduction in sperm levels was temporary. It is tough to say this study was very conclusive in that the number tested was only two.
Again each and every case is different and nothing in science is black and white; there might be ways to mitigate the effects of the SSRI. Going with a baseline test and then one later while on the SSRI might be the best route, possibly “white-knuckling” through the symptoms of depression for a few months until your wife conceives, trying a different form of antidepressant; or maybe even replacing the antidepressants with anti-anxiety medications such as a short-term course of a benzodiazepine during the period while the couple is trying to conceive. As noted earlier, there are other forms of treatment besides the antidepressants. This would be a good time to investigate those. When considering the side effects of serotonin reuptake inhibitors, remember that nearly every medicine has side effects, even the over-the-counter medications and natural supplements.
If you are seeking medication management from a psychiatrist, make certain that you inform your doctor of your plans to start a family and have a discussion about the best possible therapy.Weigh the severity of your depression against the possible side effects and temporary infertility that may be a consequence of taking the SSRIs. Read more about the side effects of serotonin reuptake inhibitors.