Beeder Lauren A, Samplaski Mary K
Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
Institute of Urology, University of Southern California, Los Angeles, California, USA.
Int J Urol. 2020 Jan;27(1):39-46. doi: 10.1111/iju.14111. Epub 2019 Sep 21.
Antidepressant medications are commonly used in males of reproductive age for long-term treatment of depression, as well as other disorders. Although antidepressants are known to be associated with sexual side-effects, their effects on semen parameters and other markers of male fertility have been less thoroughly described. The majority of available studies have focused on selective serotonin reuptake inhibitors, which have been shown to negatively impact semen quality in in vitro, animal and human studies. Fluoxetine, in particular, has been the subject of multiple studies and has been associated with gonadotoxic effects, including decreased sperm concentration and motility, increased deoxyribonucleic acid fragmentation, and decreased reproductive organ weights. Studies of several other selective serotonin reuptake inhibitors have yielded similar results. Reassuringly, this effect does seem to be reversible. The data regarding serotonin-norepinephrine reuptake inhibitors, norepinephrine-dopamine reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors and atypical antidepressants are sparse, varied and conflicting. Given the widespread and often long-term use of antidepressant medications, there is a clear need for further data regarding their impact on semen quality and male fertility.
抗抑郁药物常用于育龄男性，以长期治疗抑郁症及其他疾病。尽管已知抗抑郁药物会引发性方面的副作用，但其对精液参数及男性生育能力其他指标的影响尚未得到充分描述。现有的大多数研究都集中在选择性5-羟色胺再摄取抑制剂上，在体外、动物和人体研究中，这类抑制剂已被证明会对精液质量产生负面影响。特别是氟西汀，已经成为多项研究的对象，并且与性腺毒性作用有关，包括精子浓度和活力下降、脱氧核糖核酸碎片增加以及生殖器官重量减轻。对其他几种选择性5-羟色胺再摄取抑制剂的研究也得出了类似结果。令人欣慰的是，这种影响似乎是可逆的。关于5-羟色胺-去甲肾上腺素再摄取抑制剂、去甲肾上腺素-多巴胺再摄取抑制剂、三环类抗抑郁药、单胺氧化酶抑制剂和非典型抗抑郁药的数据稀少、多样且相互矛盾。鉴于抗抑郁药物的广泛且通常是长期使用，显然需要进一步了解它们对精液质量和男性生育能力影响的数据。
