Reactions 1501, p14 - 17 May 2014

Citalopram

Abnormal sperm parameters: case reportA 30-year-old man was found to have abnormal sperm

parameters during treatment with citalopram.The man with a history of β-thalassaemia had been receiving

treatment with citalopram [route and duration of treatment toreaction onset not stated] at a dose of 40 mg in the morningdaily for mixed depressive and anxiety disorder for almost3 years. Due to failure of conception after 2 years of regularsexual activity, a sperm analysis was performed whichrevealed abnormal sperm parameters with spermconcentration 11 million/ml, sperm motility 25%, progressivemotility 15% and abnormal morphology 99%. Citalopram wasdiscontinued and he experienced discontinuation symptomsincluding disturbed sleep, ’head shocks’, increased anxietyand dizziness. Follow-up sperm analysis done 4 months aftercitalopram discontinuation showed an improvement in spermparameters with a sperm concentration of 16 million/mL,motility 60% and progressive motility of 35%. Howevermorphology abnormality persisted. The couple underwent IVFand intra-cytoplasmic sperm injection treatment that wasunsuccessful due to implantation failure. After 16 months, theman experienced worsening of insomnia and anxiety,therefore he was started on agomelatine. Sperm analysis doneafter 3 months of starting agomelatine showed better resultsthan the one done during citalopram treatment, however anultrasound scan revealed evidence of clinically insignificantsmall unilateral subclinical varicocoele.

Author comment: "We report the association of abnormalsperm parameters during treatment with the SSRI citalopram,and an improvement in sperm concentration, motility,progressive motility and sperm morphology following itswithdrawal." "Using the scoring criteria proposed by Naranjo(14), the probability of causality for the observation withcitalopram was rated as 5 (probable)."Elnazer HY, et al. Treatment with citalopram, but not with agomelatine, adverselyaffects sperm parameters: A case report and translational review. ActaNeuropsychiatrica 26: 125-129, No. 2, Apr 2014 - United Kingdom 803103063

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Reactions 17 May 2014 No. 15010114-9954/14/1501-0001/$14.95 Adis © 2014 Springer International Publishing AG. All rights reserved