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In addition to the widely studied effects of estrogen, nutritional status, and genetic or physical factors on osteoporosis [129], both later sleep onset and decreased sleep quality have been identified as risk factors for osteopenia and osteoporosis [130, 131, 132, 133]

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Thus, sertraline interferes with the function of the hypothalamicpituitarytesticular and hypothalamicpituitaryadrenal axes by affecting the wide distribution of serotonin receptors, thereby leading to reduced fertility in male rats (Figure 3)

Concurrently, pro-inflammatory cytokines regulate the activity of key enzymes in tryptophan metabolismindoleamine IDO and TDOpromoting the production of kynurenine pathway metabolites such as KYNA