Dados do Trabalho

Title

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) AND THEIR INFLUENCE ON MALE FERTILITY

Objective

We aimed to discuss the main findings related to adverse effects of SSRI drugs on male fertility, considering hormone levels, sexual function, seminal parameters and sperm function.

Methods

This study is a systematic review about the research question: "What adverse effect(s) and influence(s) do the main SSRI have on male fertility?". Search strategy included: (male infertility) OR (male fertility) AND (serotonin uptake inhibitor) OR (antidepressant agent) OR (sertraline) OR (fluoxetine) OR (paroxetine) OR (citalopram) OR (escitalopram) OR (fluvoxamine) OR (vilazodone) AND (semen analysis) OR (DNA damage) OR (spermatogenesis) OR (sexual dysfunction), with addition of filters from the last ten years and types of studies for randomized controlled trial, clinical study, clinical trial, case report, prospective study, retrospective study, animal experiment and systematic review. The databases chosen were EMBASE and LILACS/BVS. For the selection of studies, the inclusion criteria were carried out, considering the English language, studies that were exclusively with the main drugs of the class of the SSRI, work done with mice and rats, as well as studies with humans. In terms of exclusion, other alternative models, literature reviews, editorials, as well as other drugs in the class that were not in the search strategy were disregarded.

Results

A total of 125 studies were found (8 LILACS/BVS and 117 EMBASE), 7 of which were considered duplicates by PICOportal. By screening the reading of the abstract, by two independent researchers, 18 were included and 100 were excluded, following the exclusion and inclusion criteria. Finally, for full text, 13 publications were considered. All analyzes followed the PRISMA Statement 2020. Of the compiled articles, vilazodone, fluvoxamine and escitalopram were not cited, most studies point to fluoxetine as the drug most used in research on the subject. Most studies are experimental in mice or rats. The authors worked with biochemical markers, comparing them with the main drugs chosen in the present research, in a way that demonstrated gonadotoxic effects, ejaculatory dysfunction, failures in spermatogenesis, in morphology, decrease in sperm production and progressive motility, in addition to questioning sertraline, fluoxetine, citalopram and paroxetine, as possible oxidative stressors. However, other studies have pointed out that the use of SSRIs do not affect sperm DNA, on the contrary, they would act as antioxidants, bringing variability and making it difficult to reach a real consensus on the influence of these therapies. The use of extracts or natural products can corroborate the decrease in the impact caused by paroxetine, thus being relevant for the control of hormonal parameters and the adverse effects caused by SSRIs. In addition, the dosage of drugs is quite varied, but all claim that high doses of SSRIs decreased hormone levels (LH, FSH, Testosterone). The use of those causes even greater effects with increasing age.

Conclusion

Considering that this drug therapy may have a longer duration, their effects on fertility need to be considered. On the other hand, even though studies point to adverse effects of the use of SSRIs, more randomized and experimental clinical research is needed to evaluate the mechanisms of spermatogenic failure, as well as to investigate the criteria underlying these effects, in male fertility. Proposing tools for therapeutic monitoring of these drugs in the seminal fluid, or other parameters, can be good allies in the investigation, minimizing the possibles risks.

Keywords

psychotropic; male fertility; spermatogenesis; seminal analysis; sexual dysfunction.