In 2011, the CDC reported that at least 11% of Americans are on antidepressant medications, of which SSRIs (selective serotonin reuptake inhibitors) are the most common type. SSRIs are famous for having sexual side effects such as decreased desire, erectile dysfunction, delayed ejaculation, and inability to achieve orgasm. Not as frequently talked about, however, is the negative effect that SSRIs have on sperm quantity and quality.
In the last 20 years, SSRIs have become the first choice of treatment for depression as well as anxiety, panic, and OCD. And they are prescribed not only by psychiatrists, but also by Family Medicine Practitioners, Internists, Cardiologists, Gynecologists, and Neurologists. Although transient GI side effects such as nausea and soft stools are very common, as are the longer term side effects of insomnia, fatigue, and constipation, the benefits of treatment usually outweigh the risk of these side effects.
In many cases, these medications are extremely necessary and I am certainly not recommending that people stop taking their medications. Nor am I recommending that a person go without proper treatment that they may need simply because of side effects. What I am recommending is that people understand the effects of medications so that they can plan around it. Such is the case for men taking SSRIs who might be planning on conceiving with their partner.
It has been shown that SSRIs can significantly lower levels of testosterone and estrogen after just 5 weeks of taking the medications. Other studies have demonstrated a decrease in sperm motility and viability during treatment with SSRIs that started to improve within a few weeks of stopping the medication. But a new study recently demonstrated actual changes in a man’s sperm after being treated with an SSRI after 3 months. Specifically, researchers found that concentration (amount), motility (ability to move properly), and morphology (normal shape) all fell more than 50% at the end of the three month period, and these effects were seen in 100% of the men treated. This is considered a significant decrease that could place some men into the ‘infertile’ range.
Although small changes appeared after the first month of treatment, it wasn’t until after the third month that the numbers really started to drop. Researchers note that this would be a logical finding since sperm production takes about 64 days, therefore sperm changes would be most evident after the two and a half month mark. What is worrisome to me is that in questioning other colleagues of mine, it does not seem that these side effects are common knowledge, yet these medications are continued to be prescribed in increasing quantities. Now SSRIs are also being used to help some men overcome premature ejaculation with good results. As the use of these medications continues to increase, a serious discussion about side effects needs to take place, especially in men planning on starting a family so that they can plan accordingly if they should have any difficulty conceiving.
Doctor, Do you think there is also a connection between male infertilty and male sexual desire? To be more specific, if a man knows he is sterile, can it affect the way he desires sexual relations? I ask because I found out early in marriage that I was sterile due to a botched surgery as a child. I think my self esteem and being has suffered because of it. Lack of bedroom confidence, ED and other matters seem to be the norm anymore with me. I have been seeing and still seeing a psychologist about this and many other issues. Do you have any thoughts about this? I find it amazing the effect sexual issues have on the body and vice versa. It sort of “feeds off itself”
@eammon – Yes, the mind and body are always responding to what is happening in the other. Ed is often caused by anxiety, and sexual desire can be impacted by many different psychological issues. For example, if a man views his fertility as as a defining part of his “manhood”, being sterile or infertile may very well affect his level of sexual desire. For other men, being infertile may have no impact. However, if being sterile/infertile is a result of abnormally low testosterone or another biological process, it will affect sexual desire because of the testosterone. There are many factors that contribute to our sexual health, balance, and functioning. That is why I do the job that I do.
Thank you Do much
I did not know that my sexual and fertility frustrations could be caused by my medication. I was depressed due to fear of sexual intimacy. The medications are increasing my fears. I have found myself in a cascade of low self esteem issues.
I have Reflex Sympathetic Distrophy. I take anti depressants and morphine daily for the last 15 years. I also get testosterone injections bi weekly. I have been having trouble orgasming for a while now. I am not able to stop my mess. Any helpful suggestions to help me finish with a orgasm?
Desperate in Ohio
Joe, You haven’t mentioned where anatomically the RSD affects you, but the medications that you take can severely curtail your ability to reach orgasm. Antidepressants, especially the SSRIs can delay orgasm or even make it impossible for some to reach. But worse than that, morphine and other opioids can dampen your brain’s functioning and also make it difficult, if not impossible, to reach orgasm. Chronic use of opioids also decreases your natural testosterone, but so does exogenous testosterone replacement because of the pituitary’s negative feedback loop. Have you spoken to your MD’s about the sexual dysfunction so that they can try tweaking your meds and try to improve this? Wellbutrin as an antidepressant usually has the least sexual side effects. But the opioids cause a serious problem. Do you have other options for pain? Reducing opioids after 15 years is VERY difficult for most people.
Hello, I have been taking Pristiq for one year. I understand that it is a relatively new SSRI and has been good with side effects for many. I experience some side effects, but these are minimal and I can deal with them. My wife is wanting to have another child and we have been trying for a few years now. Although she is 44, we have been pregnant once about two years ago and we have three other children. She believes that the pristiq is causing me to be infertile.
I have not found any other evidence or any other person’s experience that this has been a side effect of taking pristiq.
What are your thoughts?
Darren – Pristiq does have some serotonin reuptake inhibition, and we know that SSRIs can affect sperm motility. It is possible to have as much as a 50% change in normal sperm when taking an SSRI, and by association, maybe also SNRIs. It is very likely, however, is that she is not ovulating regularly given her age. Fertility in women significantly decreases after 38 and almost gone by 45. Has she consulted her gynecologist? They can check her FSH and LH levels as well as her Estrogen (Estradiol) level and Progesterone (on day 21 of her cycle) to get a good idea if she is ovulating or not. Most women approaching 45 are unable to get pregnant, even with IVF (in vitro fertilization) so many have to use a donor egg if they want to get pregnant.
My brother is very much depressed upto the limit that he’s nearly suicidal but the main cause of his depression is not able to have a baby since past 3 years (my sister in law had 2 miscarriages). His sperm count and quality etc as for now is all normal as per recent reports, so is my sister in laws reports normal. But as stated, if he takes SSRI then his chances to get a baby are further lowered. Are there any alternate antidepressents which do not affect in fertility and sexual matters? Your reply will be highly appreciated. Thank you
Suzzane – when someone is depressed to the level of contemplating suicide, there is a lot more going on than just upset that he cannot have a baby. For such a dramatic response, there may be issues of his identity and manhood tied into his virility that is driving his depression. Whatever the case, for someone like this, they would benefit from optimizing their diet and lifestyle to maximize not only their sperm count, but also their mood and well-being as well. Cut out gluten and dairy from the diet entirely, supplement with Zinc 20mg 2x/day, Copper 1mg 2x/day, Selenium 200mcg 2x/day, Vit D3 5000 Units daily, Methyl-B12 1000mcg 2x/day, methyl-folate 800mg 2x/day at least. In this situation, a person should also be getting appropriate sleep with the cycle of the sun – 10pm-6am, and start to address how they deal with stress in their lives. To date, I believe that all antidepressant medications can have a negative effect on sperm. But remember, you only need 1!
My husband is taking Trazodone and we have been trying to have another baby for 7 months now. I had my iud removed in Jan. and i havent gotten pregnant yet. Will the Trazodone make my husband infertile?
Janette – Trazodone could theoretically affect the shape and motility of developing sperm, so it could lower his effective sperm count. The sperm are still there, just less able to fertilize the egg. Is he taking it for sleep? Since sperm take about 2-3 months to develop, sperm counts and morphology (shape) will return back after stopping the medication. The bigger question is why does he need the medication? If he really needs it, then realize that medications such as this don’t have a total effect on sperm. Perhaps he should speak with his doctor about it to see if there are alternatives. I would suggest you ask about any other medications he may be taking too.
Is there anything we can do without him stop taking the medicine?
Thank you for your quick response. He is taking it for PTSD and then he is taking Bupropin also. He has severe PTSD and sleep problems.
My husband has been taking celexa for about 5months now we have been trying to conceive for the past 3 with no luck. We have two other children and got pregnant first try which I know that doesn’t always happen although we just assumed it would the third time. My husband needs the medicine for panic attack and were not really in a hurry to get pregnant. But I’m reading thay ssri’s change the quantity and quality of sperm and my question is is it safe for me to become pregnant if his sperm aren’t healthy ?? Can it change sperm DNa are birth defects possible? I know it may take us longer to get pregnant because of Sperm count but I don’t want to do it if when it happens it may not be considered a healthy pregnancy. A response would greatly be appreciated thank you!
I am Adam, 29 years male. I took Seroxat 20 mg for few years(almost 4 years with very few discontinuation) for anxiety disorder. Now I am married for one year. I stopped seroxat after two months of marriage after knowing it may effect sperms. now for last 9 months I have been surviving without seroxat as we are planning a baby but still no result yet. Last month (8 months after stopping seroxat) I tested my serum and got low motility (35%) morphology(55%) sperm count 70M/ml and rest of results were fine. Doctor says I have little issue and prescribed vitamin e and one other herbal meds for motility improvement.
But these days my anxiety is back and sever and I feel like I should take one for few days. My dr has prescribed me Zoloft 50 this time with vitamin E (400 mg twice)
I am confused about taking this anti depressant as my wife is working hard for her PCOs treatment and we may expect any time if get lucky.
But I want to know if I should go for zoloft or seroxat now? or should I survive using clonazipam/ bronazipam / alperazolam?
Or can I take any of mentioned SSRIs with evion 400mg + herbal meds.
Looking forward for your response.
Adam – I cannot give you specific advice, but I can speak to general topics. The Zoloft is another SSRI, so it will also affect sperm morphology and motility. The vitamin E could be helpful, but taking appropriate levels of Zinc and Selenium will also be very important with someone trying to maximize their sperm count. Zinc 20mg with Copper 2mg twice a day along with Selenium 200mcg twice a day are needed for appropriate testosterone production as well as most other functions of the body. Some people with anxiety are able to work with a therapist to avoid medications. Other people just really cannot do it without medications unfortunately. The benzodiazepines like clonazepam, alprazolam, lorazepam, etc. are tranquilizers which help with anxiety, but cause a rebound anxiety, making it difficult to get off of them. Benzo’s also can affect sperm count by affecting the sperm mitochondria. You will have to weigh all the options with your doctors/therapists and decide what’s best for you and your wife. Best Wishes!
Even though I am against taking medications, I began taking Serdep 25mg (Antidepressant) 2 weeks ago. I don’t know what else to do to get my head to feel better. So far no improvement. In fact it has made me definitely more “heavy” in the head/ sleepy and has definitely reduced sex cravings and my sperm is looking clearer in colour. My head has been “heavy”, “brain drained” for some years now, so I was hoping SSRI could fix it. When I started having bad dreams and trouble sleeping 1 month ago I had to do something. I’m not sure if I’m on the right path to fix my brain issues….any advice ?
Have you tried regular exercise? It has the same success rate as SSRIs for anxiety and depression. It also normalized your sleep and stages of sleep. Also, I advocate cutting out all gluten, dairy, artificial ingredients, sugar, and non-organic foods in order to decrease your systemic inflammation which has shown to cause depression and anxiety.
My partner was on a high dose of Antidepressants when I fell pregnant with my third child and she is the only one who has learning difficulties and behavioural issues could this be linked to his taking the medication 150/175 fluoxetine (prozac) a little knowledge on this would be gratefully received
Kindest Regards Tracey
Studies show that SSRIs cause DNA fragmentation, which affects the structure and function of sperm. We all have 2 copies of all of our genes (except men and those genes on Y chromosome), which helps protect against errors. At this point, she is already born, so focusing on what might have happened before conception won’t move you forward. Instead, eliminating all gluten, dairy, sugar, pesticides, artificial colors, preservatives, etc. will be your best hope at giving her a healthy brain. All of these things cause inflammation and are known to cause behavioral issues and learning difficulties.
My husband has been and is currently taking Duloxetine a serotonin-norepinephrine reuptake inhibitor (SNRI). I am wondering if the sperm quantity and quality side effect mentioned above for SSRI’s is also a side effect for SNRI’s. We have been trying to conceive our 3rd child for 3 months now, timing sex with my most fertile days, to no avail and I am wondering if I should discuss this possible side effect with him.
I am also wondering if there is any research or statistics on miscarriage rates for conception with sperm effected by SNRI’s or, in reference to the above post, if there is any information on developmental disabilities in children conceived from Sperm effected by SNRI use.
Thank you for your time, and I hope to hear from you.
Theoretically, it could affect trying to get pregnant because there are less normal sperm available to reach the egg and fertilize it. 3 months is still a little early to jump to conclusions. He could have his sperm tested if you were very concerned. As far as studies on miscarriages or developmental disabilities, the only ones I found had to do with the mother taking SSRIs, not the father prior to conception.
45 yrs old … i have stopped taking Paxil and Xanax and Benzodiazepines… was on them for many YEARS!!! then for the last 2 yrs was on Paxil… all lead to numbness nightmares erectile problems etc.. was SICK of it!!! .. i came off of all of them gradually, .. i have regained sexual feeling and my penis responds now to women i am with, but i am dismayed as my sperm is totally CLEAR!!! i do not masturbate, have not for YEARS!!! .. been clean for 1 month so far, i eat good, and have always exercised and still am … just need to know in time will my white sperm come back? … like if i make sure i am doing as you say … ( Cut out gluten and dairy from the diet entirely, supplement with Zinc 20mg 2x/day, Copper 1mg 2x/day, Selenium 200mcg 2x/day, Vit D3 5000 Units daily, Methyl-B12 1000mcg 2x/day, methyl-folate 800mg 2x/day at least. In this situation, a person should also be getting appropriate sleep with the cycle of the sun – 10pm-6am ) …
Russ – have you had a count done to see if you are deficient in sperm or are you just going by the color?
My husband has been on escitalopram for his anger for well over a year now. We decided to get a vasectomy reversal done last February and his sperm count has remained at zero. I am just wondering if this medication was the reason for this? I have been doing research and he stopped taking the medicine after I found out it could hurt his fertility.
Denise – usually the sperm develop well after the medication is stopped. The medication doesn’t bring the count to zero, so there are still sperm, but their shape and motility is not all perfect. If the sperm count is zero, perhaps the reversal may not have been successful? There should be some sperm present if the reversal worked.
I have low test after abusing steroids. I stopped about 4 months ago and my test level is 68. The urologist wants me to wait a month to see if they elevate naturally. My testicles are small now…I also have vericocele on my left side…I’m getting angiokeratomas too on my scrotum…this has destroyed me and my self confidence…on top of this I am unemployed and lost a relationship with a woman of 6 years…I’m lost and feel I’ll never have any confidence in anything anymore. I’m 41 yrs old.
Tyler – a person’s body has to readjust after using steroids because the brain has to first sense the lower level of steroids, then start sending signals down to the testicles once again. My suggestion for anyone is to do all of things that help balance the body’s production of hormones so that it can get back into it’s regular cycles. This includes 7-8 hrs sleep every night, no alcohol, no sugar, supplementation with Vitamin D, Zinc, Selenium, and fish oils, and a gentle combination of cardio and resistance training. The body will not go back to producing good levels of testosterone if you are too stressed out either, so don’t do extreme exercise and do something that makes you feel happy and fulfilled every day.
My husband and I are having trouble conceiving our 2nd child. Our 1st child was conceived 2 year ago. At the time my husband was taking 50mg of sertraline and had stopped it all together 2-3 weeks before we conceived. He is currently taking 100 mg of sertraline and we have been trying for over 6 months. He is getting a semen analysis this week. If his numbers are low and he decides after talking with his doctor to stop his medication would it be 3 months till we saw a change in his sperm?
Sperm take roughly 70 days to mature, so the standard practice is to wait about 3 months. In the meantime, a man wishing to optimize his production and hormone levels can start by taking Zinc 20mg twice a day, Selenium 200mcg twice a day, and Vit D 2000 IUs daily with a meal.
My hubby is on 150mg of Pristiq.
This being a fairly new product on the market there isn’t much info on infertility.
He suffers from not being able to ejaculate which is a problem in itself.
If it takes 60 days for sperm to regenerate and 3 months to come of the meds. What is a better medication for him to use?
We reduced the meds to 100mg with him needing to increase over a 4 week time frame.
I’m sorry that this is such a problem for you both. Sperm technically take 72 days, so expect any effects of medication affecting morphology and motility to take almost 3 months off meds to correct. I can advise you on exactly what he should or should not take because I am not his physician and I cannot dispense medical advice here. I am a functional medicine physician and often work with clients to balance their depression and anxiety through nutrition and lifestyle so that they can often reduce or eliminate their medications – but I cannot recommend that he change or come off his medications unless he is working with a qualified professional to help balance and correct his mood first, then help him taper as tolerated. Best Wishes.