| Sažetak | Cilj istraživanja: Cilj ovog rada je pregledno i sustavno prikazati utjecaj pojedinih skupina psihofarmaka na mušku i žensku fertilnost. Obzirom na trenutno dostupne podatke, hipoteza je da će određene skupine psihofarmaka imati nepoželjan utjecaj na mušku i žensku fertilnost.
Materijal i metode: Istraživanja u okviru ovog završnog specijalističkog rada bila su teorijskog karaktera i uključivala su detaljan pregled stručne i znanstvene literature o utjecaju psihofarmaka na fertilnost. Prikupljeni su podaci o indikacijama, mehanizmu djelovanja te o provedenim istraživanjima o utjecaju na plodnost. Pretraživane su dostupne knjige iz ovog područja, baza lijekova Hrvatske agencije za lijekove i medicinske proizvode (HALMED) te Europske agencije za lijekove (EMA), publikacije stručnih udruga i institucija, znanstveni članci te drugi raspoloživi izvori. Ključne riječi za pretraživanje baza podataka (PubMed, UpToDate, ScienceDirect, Cochrane, Google Scholar) uključivale su sljedeće pojmove: antidepressants, antipsychotics, anxiolytics, bipolar disorders, mood stabilizers, lithium, fertility, fecundity, benzodiazepines, psychiatric illness, psychotropics, schizophrenia, hypnotics, side effects, reproductive system itd.
Pregledom dostupne literature prikupljeni su podaci te su nakon sistematiziranja i obrade prikazani i interpretirani. Rezultati: Istraživanja ukazuju na to da neki antipsihotici mogu izazvati hiperprolaktinemiju kao nuspojavu, što može dovesti do problema s reproduktivnim sustavom i smanjene plodnosti kod muškaraca i žena. Studije su pokazale da su risperidon, paliperidon i haloperidol najčešći uzročnici hiperprolaktinemije, dok je rizik od hiperprolaktinemije vrlo nizak kod aripiprazola. Postoji malo istraživanja koja se bave utjecajem anksiolitika, sedativa i hipnotika na plodnost, a postojeći rezultati su oprečni, stoga je teško donijeti zaključak o njihovom utjecaju na
plodnost. Seksualna disfunkcija kao nuspojava antidepresiva može imati negativan utjecaj na reprodukciju, ali su potrebna daljnja istraživanja koja bi nedvojbeno potvrdila utjecaj antidepresiva na plodnost. Prema trenutnim podacima, selektivni inhibitori ponovne pohrane serotonina (SSRI) pokazuju negativan utjecaj na plodnost, dok su podaci o ostalim skupinama antidepresiva nedostatni. Za lijekove poput litija i karbamazepina trenutno ne postoje podaci koji bi ukazivali na negativan utjecaj na plodnost kod žena, ali neka istraživanja sugeriraju negativan utjecaj na kvalitetu sperme kod muškaraca. Što se tiče valproata, postoje podaci koji ukazuju na negativan utjecaj na reproduktivno zdravlje kod ljudi.
Zaključci: Mentalni poremećaji predstavljaju veliko opterećenje za zdravstveni sustav, a procjenjuje se da jedna od osam osoba boluje od nekog mentalnog poremećaja. Važno je istaknuti da se većina mentalnih poremećaja prvi put javlja u mlađoj dobi što znači da se te osobe nalaze u fertilnoj dobi i potencijalno razmišljaju o osnivanju obitelji. Izbor terapije za pacijente u fertilnoj dobi s mentalnim poremećajima je izazovan. Treba uzeti u obzir trenutno stanje pacijenta, terapijske ciljeve i želje za osnivanjem obitelji. Ako pacijent planira osnivanje obitelji, potrebno je odabrati lijek s najmanjim potencijalom za izazivanje štetnih učinaka na njihovu plodnost. |
| Sažetak (engleski) | Research objective: The aim of this study is to provide a comprehensive and systematic overview of the impact of different classes of psychotropic medications on male and female fertility. Based on the currently available data, the hypothesis is that certain classes of psychotropic medications may have adverse effects on male and female fertility.
Materials and methods: The research conducted for this final specialist paper was of a theoretical nature and involved a detailed review of professional and scientific literature on the impact of psychotropic medications on fertility. Data on indications, mechanisms of action, and studies on the effects on fertility were collected. Available books in this field, the Croatian Agency for Medicinal Products and Medical Devices (HALMED) and the European Medicines Agency (EMA) databases, publications from professional associations and institutions, scientific articles, and other relevant sources were searched. Keywords used for database searches (PubMed, UpToDate, ScienceDirect, Cochrane, Google Scholar) included terms such as antidepressants, antipsychotics, anxiolytics, bipolar disorders, mood stabilizers, lithium, fertility, fecundity, benzodiazepines, psychiatric illness, psychotropics, schizophrenia, hypnotics, side effects, reproductive system, etc.
The collected data from the literature review were organized, processed, and presented in an interpretive manner.
Results: Research indicates that certain antipsychotics can cause hyperprolactinemia as a side effect, which can lead to reproductive system problems and reduced fertility in both males and females. Studies have shown that risperidone, paliperidone, and haloperidol are the most common causes of hyperprolactinemia, while the risk is very low with aripiprazole.
IV
There is limited research on the impact of anxiolytics, sedatives, and hypnotics on fertility, and the existing results are inconclusive, making it difficult to draw definitive conclusions about their effects on fertility. Sexual dysfunction as a side effect of antidepressants can have a negative impact on reproduction, but further research is needed to confirm the effects of antidepressants on fertility. According to current data, selective serotonin reuptake inhibitors (SSRIs) have a negative impact on fertility, while data on other classes of antidepressants are scarce.
Currently, there is no evidence suggesting a negative impact on fertility in women for medications such as lithium and carbamazepine, but some studies suggest a negative effect on sperm quality in males. Regarding valproate, data indicate a negative impact on reproductive health in humans.
Conclusions: Mental disorders represent a significant burden on the healthcare system, with an estimated one in eight individuals suffering from a mental disorder. It is important to note that most mental disorders first emerge at a younger age, meaning that individuals affected are in their reproductive years and may be considering starting a family.
The selection of therapy for patients of reproductive age with mental disorders is challenging. Factors such as the patient's current condition, therapeutic goals, and desires for starting a family should be taken into account. If a patient plans to start a family, medication with the least potential for adverse effects on fertility should be chosen. |
