Mood Disorders and Reduced Ejaculate Volume
Mood disorders themselves do not directly cause reduced ejaculate volume, but the antidepressant medications used to treat them—particularly SSRIs—can affect ejaculatory function by causing delayed ejaculation or orgasmic dysfunction, not reduced semen volume. 1, 2
Understanding the Distinction
The key issue here is differentiating between ejaculatory dysfunction (timing and control) versus actual semen volume reduction:
- Depression and anxiety primarily affect libido and ejaculatory latency (the time to ejaculation), not the physical volume of ejaculate produced 1, 2
- Anhedonia, a core symptom of depression, manifests as loss of libido and reduced sexual interest rather than changes in semen parameters 2
- Psychological factors associated with mood disorders—including depression and anxiety—are linked to premature ejaculation and ejaculatory control issues, not volume reduction 3
When Medications Enter the Picture
If this patient begins treatment with antidepressants, the situation changes:
- SSRIs (paroxetine, sertraline, fluoxetine, citalopram) cause delayed ejaculation and orgasmic dysfunction in a dose-dependent manner, but do not reduce ejaculate volume 3, 1, 2
- These medications work by stimulating 5-HT2 receptors, which affects ejaculatory timing centrally, not seminal fluid production peripherally 2, 4
- Tricyclic antidepressants like clomipramine similarly affect ejaculatory latency without reducing volume 3
What Actually Causes Low Ejaculate Volume
If your patient truly has reduced ejaculate volume (<1.4 mL), consider these organic causes instead:
- Distal genital tract obstruction (ejaculatory duct obstruction or congenital bilateral absence of vas deferens) produces low volume with acidic pH 3
- Retrograde ejaculation causes reduced antegrade volume as semen flows backward into the bladder, but this occurs independently of mood disorders 5, 4
- Hypogonadism, prostate pathology, or incomplete ejaculation from performance anxiety are alternative explanations 3
Clinical Approach for This Patient
For a male with new-onset low mood and anxiety reporting reduced ejaculate volume:
- First, clarify whether the complaint is truly about volume versus ejaculatory dysfunction (delayed orgasm, reduced intensity, or control issues) 3
- Obtain a detailed sexual history including timing of symptoms relative to mood changes, frequency of sexual activity, and any medication use 3
- Perform a focused physical examination to assess testicular size, epididymal consistency, and presence of vas deferens to rule out anatomic causes 3
- Consider post-ejaculatory urinalysis if retrograde ejaculation is suspected 3, 4
Important Caveat
If the patient has not yet started antidepressant treatment, the mood disorder itself is unlikely to be the cause of reduced ejaculate volume. 1, 2 Look for other etiologies including anatomic obstruction, retrograde ejaculation, or misperception of normal variation. The association between mood disorders and sexual dysfunction primarily involves libido, arousal, and orgasmic function—not semen production. 1, 2