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Depression and Pregnancy: Signs, Symptoms & Treatment

Depression is a type of mood disorder that causes feelings of sadness and hopelessness in both men and women. It is normal to feel down from time to time, but when you’re depressed, these feelings can last for weeks or even months. Depression can affect every aspect of your life, from how you think, to what you eat, and ultimately, how you behave. As women go through the many stages of pregnancy, they will experience hormonal shifts in the body, which can also lead to a relapse. Some women can develop the first signs of postpartum depression (PPD) during pregnancy. WebMD published an article stating that about 10% to 20% of moms-to-be struggle with symptoms of depression.

Before we dive into this Q&A piece by Dr. Maria Costantini with RMANJ, we would like to point out that depression is an illness, not a choice. Clinical depression is unlikely to go away without treatment, but options are available to control these mood disorders. Your emotional health is just as important as your physical health, so if you think you are experiencing signs of depression, contact your primary care physician.

 

Does depression affect a woman’s chances of conceiving in any way? If so, are there any studies currently out that shed light on how a woman’s body is affected by emotions and brain chemistry? Is there a hormonal element to depression that may interfere with conception?

Here at Reproductive Medicine Associates of New Jersey as well as many other fertility centers around the US, the connection between depression and or anxiety and your ability to get or stay pregnant has been studied. Unfortunately, we still don’t have enough hard evidence to come to a solid conclusion just yet.

However, the data and research that we do have suggest that some connection between depression and infertility exist. We know that hormone levels in depressed individuals fluctuate greatly, and infertility is basically an imbalance of hormones which are caused by mixed signals coming from the brain that impact the reproductive system. Depression may also lead to a lowered sex drive, increased drinking, smoking, and poor nutrition all of which can have a bad effect on getting pregnant.

 

What about stress and anxiety disorders? Do they affect fertility?

Yes, stress and anxiety disorders can impact the chance of getting pregnant for many hopeful parents.  Two of the major hormones associated with stress and anxiety are adrenaline and cortisol. Both hormones are clearly elevated in the presence of stress and anxiety and both can disrupt your reproductive system.  While studies have shown that there is a link between the two systems, a direct cause and effect have not been proven.

I personally have conducted research on this issue. Just last year, I presented the results of my research at the American Society for Reproductive Medicine (ASRM) in Salt Lake City and showed that whatever the association between stress and infertility may be, proper treatment can overcome those issues. In other words, your true reproductive potential will not be decreased by your degree of psychological distress. Specifically,  IVF treatment can boost and have a positive effect on the natural hormonal environment and that can overcome whatever bad effects stress, depression, or anxiety may have on a patient’s fertility potential.

 

Can a man’s depression affect his sperm count?

We cannot say definitively whether depression affects sperm count, but there are studies to suggest that depression may affect male fertility as well.

 

In the experience of RMA doctors, can fertility issues cause depression and anxiety in patients? and if so, what is their recommendation to patients who become depressed while trying to conceive?   

Symptoms of depression and anxiety are commonly experienced by women struggling with infertility, especially if the problem has been long-standing. If you’ve been trying to get pregnant or can’t stay pregnant after 6-12 months it’s time to take the next step and speak to a reproductive specialist. That phone call alone can make you feel better and provide some clarity.

Mental health professionals are usually available at infertility centers and could provide a valuable sounding board that’s judgment-free.  At Reproductive Medicine Associates of New Jersey, there are support groups where patients can benefit from the experiences of other couples struggling with the same issues. These support groups are often run by social workers or psychologists.

Patient-initiated online social groups like FERTILITALK also exist, where new patients can connect with patients who’ve “been there and done that.”  We also offer yoga classes and acupuncture services that can help manage the high levels of stress and anxiety for many of our patients.

 

Do antidepressants or anti-anxiety medications affect fertility? 

Antidepressants or anti-anxiety medications may indirectly affect fertility by potentially decreasing libido, arousal and orgasmic function in both men and women and potentially lead to erectile dysfunction in men.

It’s very important for patients to be counseled on these issues by their mental health providers prior to attempting conception.  The decision to either taper those medications prior to pregnancy or for patients unable to stop these medications, to switch to the least teratogenic ones, it is an important process of the preconception counseling that we have all patients complete prior to the initiation of fertility treatment.

 

Finally, what advice could you share about the issues of depression while attempting to conceive? 

Ultimately, it is important to acknowledge that stress, depression, and anxiety are common experiences that affect many patients experiencing infertility and eventually undergoing treatment.  The biggest concern is that depression can keep people from reaching out to others, from seeking infertility treatment, and from sticking with proper treatments if they are not getting immediate results.

Talking to others can help and it is important to know that you are not alone. We encourage patients to reach out to their doctors and nurses with all of their concerns and fears.  The world of infertility can feel like a very lonely one but it doesn’t have to be.  Most importantly, while these symptoms are painful to deal with, they will not likely interfere with the outcome of their treatment.



Maria Costantini Ferrando MD, FACOG

Reproductive Medicine Associates of New Jersey - Englewood, NJ

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