Q:  Q's re: BP & Sexual Dysfunction in Men

What is the relationship with bipolar and SD in men? My partner takes apo-sertraline & lithium for mood stabilization and zopliclone for sleep. Is the lack of interest and difficulty in maintaining an erection strictly related to medication or is it also part of the disorder? Is there any help available? Also, would these meds have any affect on the sperm quality/health if pregnancy were considered? Thank you. 


Dear Helene --

Sexual dysfunction (SD) is more likely to be associated with sertraline (formerly Zoloft the United States, now available as a generic) is with lithium. Because mood disorders can often complicate sexual function, sometimes it is difficult sorting out the condition from the medication in terms of what is causing more trouble. Then of course there is the romantic relationship itself, which can also cause trouble, but we will assume for now things are okay there. On this list of "likely suspects", then, sertraline is the most obvious, but not the only one.

Of course neither you nor your partner and would take this information and start changing the medications without talking with the prescriber, would you? Of course not. All sorts of unintended consequences might follow.

As for zopiclone, I'm not sure we have enough experience with it yet as regards its impact on sexual function. Sexual problems are not listed among the side effects which developed during the clinical trials (as judged by the Prescribing Information), up but because people are often not forthcoming with this kind of information, such problems tend to be underreported in general and as it can take awhile with us using the medication clinically to start hearing about such issues.

Having never heard of any trouble with fertility in men taking lithium, I searched on Google using "lithium sperm" and found a few articles describing decreased motility. Searching "lithium fertility" yielded one article describing decreased fertility in male rats, about a 50 % reduction (Thakur).Is this an issue in humans? I strongly doubt whether this is known to any degree. For example, it takes many years to determine if a medication might cause abnormalities in developing fetuses, when the mother is taking that medication during some or all of pregnancy. This is because the data come from "observational studies", such as pregnancy registries where women who have conceived while taking medication, or were exposed later, are tracked and the health of their babies recorded. To my knowledge, there is no pregnancy registry following babies whose father was taking a medication.

At least in the case of lithium, the advantage is that this medication has been in use for so long, even relatively obscure connections, such as to decreased fertility, might have manifest themselves, or a least raised some suspicion. I'm not aware of any suspicion of lithium in this respect, i.e. decreased fertility. For any medication which has been in use for a shorter period of time, we would have proportionally less ability to detect a connection. I hope that makes sense. As you can see, it means we know very little about zopiclone; and maybe have just enough experience with sertraline not to be worried about it much, except for its effect on sexual function overall.

I hope that information proves to be useful. Remember, it is just a little bit of information. Be cautious about using it to reach any particular conclusions. Good luck with that.

Dr. Phelps