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Is It Just the Emotions of Infertility or Depression?

Diagnosing and Treating Depression During Infertility

The best way to deal with depression is to first see your healthcare provider or counselor. The earlier you seek help, the sooner you can start feeling better. There are many ways to treat depression, such as medications and talking with a trained therapist.
However, depression may be treated differently for couples going through infertility. Diagnosing depression can be difficult for infertile couples. Healthcare providers have to strike a delicate balance between treating infertility without exacerbating the depression -- and vice versa.
For example, some women who are taking certain fertility medications, such as clomiphene citrate, may experience side effects from the drug. Some of the common side effects of fertility drugs such as clomiphene citrate may include:
 
  • Irritability
  • Anxiety
  • Mood swings
  • Depression
  • Psychosis.
Progesterone products that are commonly used during fertility treatments may also cause several mood symptoms similar to those of depression.
Because the side effects of many fertility medications can mimic depression, it can be difficult to diagnose depression in those going through infertility. Treating depression in infertility can be complicated by the need to consider the effects of chosen medications on conception. The safety of using antidepressants while trying to become pregnant and during pregnancy is a controversial topic.
According to the American Psychiatric Association (APA) and American College of Obstetricians and Gynecologists (ACOG), using antidepressants during pregnancy can reduce birth weight, cause neonatal irritability ("poor neonatal adaption"), and cause persistent pulmonary hypertension in the newborn.
Some medications may also increase the risk for miscarriage and cardiac defects. The guidelines set up by the APA and ACOG endorse the use of antidepressants in women who have symptoms of depression that are severe and when the benefits of using the drug clearly outweigh the risks.
For many women going through infertility and depression, the primary treatment is psychotherapy. It can be safe and effective for women who are trying to become pregnant. This can include one-on-one counseling, group counseling, and cognitive behavioral therapies.

The goal of psychiatric care is often not focused on treating depression, but on getting pregnant. There is even some evidence that psychotherapy can increase pregnancy rates. Psychotherapy offers a way to address many of the emotions of infertility and depression, such as low self-esteem, shame, and social isolation.
It is important to note that if you do become pregnant and had depression during infertility, it doesn't necessarily mean that your depression will go away. Many women believe that once they become pregnant, their symptoms of depression will subside. While this may be the case for some women, it won't necessarily be true for those who have clinical depression. In fact, women who suffered from depression during infertility may have a higher risk for it during pregnancy.
Also, don't count out how your partner may be feeling. Your partner in this journey will also be going through a range of emotions and can also become depressed. Watch for signs of depression in your partner as well. Maintaining open communication with your partner, healthcare provider, and counselor will help to keep the emotions of infertility and depression from becoming worse.
Last reviewed by: Arthur Schoenstadt, MD
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