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January 31, 2022

Antidepressants and male fertility

Depression is a mental health condition that affects more than 16.1 million American adults in a given year. Many people get help from antidepressant medications, such as Zoloft (sertraline), Prozac (fluoxetine), and Lexapro (escitalopram). These drugs can be extremely beneficial for depression, especially along with psychotherapy, other stress-relieving behaviors, or anti-anxiety medications.

While they can be an important treatment, some antidepressants are associated with sexual and reproductive side effects, including loss of libido, erectile dysfunction, and a decrease in sperm quality. Let’s explore the relationship between antidepressants and male fertility, how anti-anxiety medication affects fertility, and points to consider if you’re trying to conceive or improve your sperm health.

Key takeaways

  • Antidepressants are effective treatments for depression and other mood disorders, but have been associated with sexual and reproductive side effects.
  • There is evidence that certain antidepressant medications can have a negative impact on male fertility, in terms of sperm count, sperm motility, and DNA fragmentation.
  • There is no significant evidence that anti-anxiety medication impacts male fertility; in fact, not treating chronic stress may be worse for your sperm.

Remember, always talk to your doctor before stopping your prescription medication or changing your dosage.

What are antidepressants?

Antidepressants are a type of medication used to treat depression or other mood disorders, like anxiety, obsessive-compulsive disorder, and phobias. They work by boosting the levels of specific brain chemicals, known as neurotransmitters, that play a role in regulating mood and emotion.

There are several different classes of antidepressants.

  • Selective serotonin reuptake inhibitors (SSRIs), including:
    • fluoxetine (Prozac)
    • escitalopram (Lexapro)
    • sertraline (Zoloft)
    • paroxetine (Paxil)
  • Serotonin and norepinephrine reuptake inhibitors (SNRIs), including:
    • duloxetine (Cymbalta)
    • venlafaxine (Effexor)
  • Atypical antidepressants including:
    • bupropion (Wellbutrin)
    • mirtazapine (Remeron)

Each of these drugs targets different neurotransmitters — such as serotonin, dopamine, and norepinephrine — for a similar outcome: a more positive and balanced mood.

SSRIs and SNRIs have been shown to be effective for some anxiety disorders. Still,

antidepressants are sometimes taken in conjunction with anti-anxiety medications, such as:

  • alprazolam (Xanax)
  • diazepam (Valium)
  • buspirone (Buspar)
  • lorazepam (Ativan)

How antidepressants affect you

In extensive clinical trials, antidepressants have been found to be more effective than placebo for treating depression in adults. A 2020 review shows that the effectiveness generally depends on the severity of the depression: the more severe the depression, the greater the benefit.

Antidepressants may take a few weeks to “kick in,” but when they do, they have the potential to significantly improve relationships, productivity, learning, and overall quality of life for people experiencing depression.

Antidepressants are generally safe. Possible side effects of antidepressants include:

  • nausea
  • weight gain
  • fatigue
  • dry mouth
  • sexual dysfunction

Can antidepressants affect male fertility?

There is evidence that some antidepressants may negatively impact male fertility, affecting sperm count, sperm motility, and DNA fragmentation. Studies have also found negative effects on male fertility hormones (testosterone, luteinizing hormone, and follicle-stimulating hormone) as well as oxidative stress in the testes. This effect is temporary, and sperm health can be recovered if the medication is paused.

There’s more research about SSRIs and sperm health than about other types of antidepressants. Here is what the research says and antidepressants and male fertility:

Antidepressants may affect sperm count

A 2019 scientific review found that all types of SSRIs may have a negative impact on semen parameters, including sperm count (how many sperm in total) and concentration (the number of sperm per mL of semen). An earlier study from 2015 also found that SSRIs were associated with decreased sperm concentration. Atypical antidepressants trazodone and mirtazapine may have similar effects to SSRIs, a decrease in sperm count/concentration.

When it came to other types of antidepressants, the review found mixed results. The SNRI venlafaxine didn’t have a significant effect on sperm count, but was actually associated with improvements to sperm morphology (shape/structure) and viability. The drug methylphenidate, which is a stimulant sometimes used to treat depression, increased sperm count, but also increased abnormal sperm tail morphology in animal studies.

Do antidepressants affect sperm motility?

Sperm motility is the sperm’s ability to move or “swim,” and is integral to fertility. A 2015 study found that SSRI antidepressants are associated with decreased sperm motility. And the aforementioned 2019 review found that all the human and animal studies included demonstrated an association between SSRI use and lower sperm motility.

However, some antidepressants seem to have no effect on motility. A 2021 study of 68 healthy males aged 18–65 found that 60mg of the drug duloxetine, an SNRI, had no clinically significant effect on DNA fragmentation, semen parameters, or serum hormones. Researchers concluded that duloxetine may be a good alternative to SSRIs for depression patients who are trying to conceive.

Antidepressants may increase sperm DNA fragmentation (damage)

Sperm DNA fragmentation is a break or separation in one or both strands of DNA contained within sperm, and may affect sperm’s ability to fertilize an egg. Learn more about sperm DNA fragmentation.

A 2010 study found that patients taking the SSRI paroxetine (Paxil) experienced increased DNA fragmentation levels. Prior to taking Paxil, patients’ average sperm DNA fragmentation level was 13.8%; at week 4 of treatment, levels rose to 30.3%, more than double.

Antidepressants and erectile dysfunction

Some antidepressants — especially SSRIs and SNRIS — have well-known sexual side effects, including loss of libido, delayed orgasm, delayed ejaculation, and erectile dysfunction. Researchers have hypothesized that increased levels of serotonin, a neurotransmitter linked to mood, may affect levels of other chemicals and hormones, inadvertently lowering libido and sexual function. 

When it comes to sexual health, not all antidepressants are created equal. Research shows that atypical antidepressants like bupropion and mirtazapine have a lower prevalence of sexual dysfunction. In fact, this 2005 study found that mirtazapine was an effective treatment for sexual dysfunction that came with depression: patients rated their sexual lives as increasingly improved as they continued to take the medication.

In some cases, doctors prescribe erectile dysfunction medications like sildenafil (Viagra) or tadalafil (Cialis) in addition to the patient’s antidepressants to reverse sexual side effects. These medications must be taken shortly before sex and may carry their own risks. For example, Viagra may have a negative impact on fertility.

Do anti-anxiety medications affect male fertility?

There’s no evidence that commonly prescribed anti-anxiety medications, like benzodiazepines, impact male fertility. (They may, however, contribute to a loss of libido.)

In fact, choosing not to treat one’s anxiety may have a more detrimental effect on fertility. There is evidence that chronic stress and anxiety may impact male fertility, being associated with impaired testicular function, a decrease in sperm count and motility, and a higher incidence of DNA fragmentation.

Should you stop taking antidepressants if you’re trying to conceive?

That depends on what antidepressant medication you’re taking (and your dosage), your personal fertility health, and the severity of your depression. If antidepressants are helping you manage your mental health, that’s important — especially as you consider growing your family.

Though some antidepressants may have a negative short-term impact on male fertility, it is not impossible to conceive, especially if your fertility was previously healthy. Sometimes, simply changing the medication or the dosage can make a difference.

It’s a good idea to start with a semen analysis, a test for the health of your semen and sperm. A semen analysis gives you clues as to whether your antidepressant is causing fertility issues.

And remember, always talk to your doctor first before stopping any medications or changing your dosage.

Check your sperm health with an at-home semen analysis kit and explore our guide to sperm improvement for more resources.


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