MHM Magazine

sperm from prolonged residence in the male reproductive tract. Paroxetine, in particular, has been noted for its potent delay in ejaculation. Serotonin-norepinephrine reuptake inhibitors (SNRIs) • Duloxetine: A double-blind, placebo-controlled clinical trial involving healthy males found that Duloxetine did not significantly impact semen parameters, sperm DNA fragmentation, or serum hormones, making it a potential option for men concerned about fertility. Tricyclic antidepressants (TCAs) • TCAs: Limited studies suggest that TCAs similarly affect semen volume and motility as SSRIs. Imipramine, in particular, reduces sperm viability. CASE REPORT • In a case report a 30-year- old man on Citalopram for 15 months, developed oligospermia and reduction of sperm motility. • When the Citalopram was stopped, there was a significant increase in sperm count and improvement in sperm viability 4 months after discontinuation. Elnazer & Baldwin 2014 Key points: antidepressants in males • SSRIs and TCAs are associated with harmful effects on sperm morphology, concentration, and sexual function. They should be avoided in men seeking to conceive. • SSRIs are the treatment of choice for premature ejaculation due to their effect on delaying ejaculation, while TCAs like Imipramine can treat retrograde ejaculation. • Monoamine oxidase inhibitors (MAOIs) can cause anejaculation. • Research indicates that Duloxetine, Bupropion, Mirtazapine, Vortioxetine, and Vilazodone may be more favourable for male fertility. Antipsychotics in males The blockade of dopamine D2 receptors by antipsychotics can lead to elevated prolactin levels (hyperprolactinaemia), resulting in decreased libido and erectile dysfunction, and potentially lowering fertility due to diminished GnRH secretion and reduced LH (Luteinizing Hormone) and FSH (Follicular-stimulating hormone) release. • Haloperidol and Risperidone: This medication is known to significantly increase prolactin levels, leading to sexual dysfunction. Long-term treatment maintains elevated prolactin levels. • Olanzapine: Clinical trials indicate that Olanzapine induces hyperprolactinaemia in a significant proportion of patients, although less severe than Haloperidol and Risperidone. Cases of priapism have been reported, potentially harming sexual function and fertility. • Clozapine: Unlike other antipsychotics, Clozapine does not elevate prolactin but has been associated with retrograde ejaculation. Key Points: Antipsychotics in Males • First-generation antipsychotics, phenothiazines, and Risperidone can cause hyperprolactinemia, leading to sexual dysfunction and decreased testosterone. • Olanzapine is linked with priapism in case reports. • Clozapine does not elevate prolactin but may cause retrograde ejaculation. • Aripiprazole and third- generation antipsychotics may be better options for improving fertility, though research is limited. Mood Stabilisers in Males • Lithium: This medication can reduce libido and cause erectile dysfunction through decreased central nervous system dopamine levels, affecting genital reflexes and libido. In vitro studies suggest a reduction in sperm viability. • Sodium Valproate: Associated with higher rates of abnormal sperm morphology and immotile sperm, patients on Valproate exhibit smaller testicular volumes and more frequent sexual dysfunction compared to the general population and those on Levetiracetam or Lamotrigine. Switching from Valproate to Levetiracetam or Lamotrigine has shown improvements in sperm counts and parameters. Psychiatric medication in Females SSRIs in Women SSRIs complicate sexual functioning, potentially involving nitric oxide and postsynaptic 5-HT2 receptors in the spinal cord. Sexual side effects include genital anaesthesia, loss of lubrication, and anorgasmia. SSRIs may increase FSH levels in women with decreased ovarian function, reducing fertility. Most IVF studies show no significant difference in pregnancy outcomes between those exposed to SSRIs and those who are not. Key points: antidepressants in females • Research is limited. • SSRIs do not directly cause major hormonal changes but can decrease fertility due to sexual dysfunction. • Untreated depression and anxiety may reduce fertility. • Treatment must balance the benefits against untreated mental illness. • Consider antidepressants not associated with decreased libido: Bupropion, Mirtazapine, Vortioxetine, and Vilazodone. Antipsychotics in females First-generation antipsychotics (FGAs) have a reported hyperprolactinaemia prevalence of 47.6%, induced by D2 receptor blockade on lactotroph cells. This can lead to reduced oestrogen, gonadal dysfunction, and hypogonadotropic hypogonadism, causing amenorrhea, menstrual irregularities, and infertility. If discontinuation of the hyperprolactinaemia-inducing antipsychotic is not feasible, MHM | 2025 | Volume 12 | Issue 1 | Psychiatric Medication and Fertility: Preconception Prescribing Considerations in Psychiatry MHM Issue 1 | 2025 | MENTAL HEALTH MATTERS | 7 MHM