The Food and Drug Administration (FDA) issued a warning a few years ago that pregnant women taking the selective serotonin reuptake inhibitor (SSRI) antidepressant paroxetine risk giving birth to infants with major birth defects, including heart abnormalities Now comes word that the same drug (sold as Paxil, Paxil CR, Seroxat, Pexeva, and generic paroxetine hydrochloride) carries another danger that could keep babies from being born in the first place. A new study just published in the online edition of the journal Fertility and Sterility concludes as many as fifty percent of all men taking the antidepressant could have damaged sperm and compromised fertility.
New York Presbyterian Hospital and Weill Cornell Medical Center researchers followed 35 healthy male volunteers who took paroxetine for five weeks. Then sperm samples from the men were studied using an assay called terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) to evaluate whether there were missing pieces of genetic code in the sperm DNA. This condition, know as DNA fragmentation, is associated with reproductive problems.
The results? The percentage of men with abnormal DNA fragmentation soared from less than 10 percent to 50 percent while taking the antidepressant. This is a crucial finding because DNA fragmentation has long been known to correlate with an increased risk of birth defects, poor fertility and unsuccessful pregnancy outcomes — even when high tech, extraordinarily expensive fertility enhancing techniques such as in vitro fertilization and intracytoplasmic sperm injection are used.
The study, one of the first scientific investigations into the effect of SSRIs on sperm quality, also confirmed that paroxetine impairs sexual function. More than a third of the research subjects reported significant changes in erectile function and about half had difficulty ejaculating.
“It’s fairly well known that SSRI antidepressants negatively impact erectile function and ejaculation. This study goes one step further, demonstrating that they can cause a major increase in genetic damage to sperm,” Dr. Peter Schlegel, the study’s senior author and chairman of the Department of Urology and professor of reproductive medicine at Weill Cornell Medical College, explained in a statement to the media. “Although this study doesn’t look directly at fertility, we can infer that as many as half of men taking SSRIs have a reduced ability to conceive. These men should talk with their physician about their treatment options, including non-SSRI depression medications.”
The scientists could not identify the exact way the SSRI caused the DNA fragmentation, but the evidence strongly suggests the drug slows sperm as it moves through the male reproductive tract from the testis to the ejaculatory ducts. When this happens, the sluggish sperm grows old and its DNA becomes damaged. “This is a new concept for how drugs can affect fertility and sperm. In most cases, it was previously assumed that a drug damaged sperm production, so the concept that sperm transport could be affected is novel,” Dr. Schlegel stated.
The study contains some good news for men currently on Paxil and related drugs who may be concerned about their fertility. All the changes the researchers found appeared to be totally reversible. Specifically, normal levels of sexual function and DNA fragmentation both returned to normal one month after discontinuation of the drug.
A higher dietary intake of omega-3 fatty acids may protect men from prostate cancer even if they have a genetic predisposition to the disease, researchers have found.
“We detected strong protective associations between increasing intake of long-chain omega-3 polyunsaturated fatty acids and more advanced prostate cancer,” said lead researcher John S. Witte. “These fatty acids are primarily from dark fish such as salmon.”
“And the decrease in risk may be even more pronounced if one has a high-risk genetic variant,” he said.
In a study published in the journal Clinical Cancer Research, Witte and colleagues compared the diets and genetic profiles of 466 men suffering from aggressive prostate cancer with those of 478 healthy men of similar age and ethnic distribution. Average participant age was 65, and cancer patients were recruited an average of 4.7 months after diagnosis. Healthy controls were recruited from among men undergoing standard annual health checkups.
The researchers focused only on aggressive tumors because these represent the most dangerous form of the disease. Many men with non-aggressive, slow-growing tumors die of other causes before ever experiencing any cancer symptoms.
Researchers had all participants fill out food frequency questionnaires, classifying their intake of various kinds of fish as “never,” “one to three times per month,” or “one or more times per week.” All men were screened for nine different mutations of the cox-2 gene. These variables were then analyzed for their relationship with prostate cancer, adjusting for other known risk factors such as smoking, obesity, family cancer history and prior prostate screening results.
The study was conducted by researchers from the Institute for Human Genetics, University of California and University of Southern California, and funded by the National Institute of Health and a dean’s grant from Laval University McLaughlin.
The researchers found that men with cancer had a significantly higher intake of calories, fat and linoleic acid (an omega-6) than healthy men. They had a significantly lower intake of omega-3s, shellfish and dark fish.
Men who ate dark fish one to three times a month had a 36 percent lower chance of developing an aggressive prostate cancer than those who ate it rarely or never, while those who ate such fish once a week or more had a 63 percent lower risk.
“The strongest effect was seen from eating dark fish such as salmon one or more times per week,” Witte said.
The researchers found that men with a particular cox-2 gene variant, rs4647310, had 5.5-times the risk of aggressive prostate cancer as men without that variant. This elevated risk was not seen, however, among men with a high omega-3 intake.
“Men with low intake of dark fish and the high-risk variant had a substantially increased risk of more advanced prostate cancer,” Witte said.
Omega-3s are believed to decrease the risk of cardiovascular disease, cancer, and autoimmune disorders, and to improve cognitive health. The mechanisms for these benefits are not well understood, but are believed, in some cases, to be linked to reduced inflammation.
The cox-2 gene is known to play a role in prostate inflammation, a risk factor for prostate cancer.
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