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It may seem simple enough: If you’ve been given a diagnosis of depression, you should treat it with care, especially when you’re working on bringing a baby into your family. Plus, there’s no question that infertility can compound depression, so why question whether to treat or not to treat?
San Diego acupuncturist Alex Shpigel, L.Ac. says there are many unanswered questions that warrant concern by women with depression who want to get pregnant, their partners, and their health care providers.
“Most of the worries are about the unknowns,” Shpigel says, “with a primary focus on the babies. There’s more evidence now linking a mother’s diet and medication use to abnormalities in the newborn.”
The incidence of depression among women who want to have a baby is significant. Donnielle James, L.Ac. in California explains, “Having a child is a huge commitment in terms of lifestyle, financially, and of course, expectations of others. Often there are underlying issues creating conflict that in turn creates stress and depression, both within the patient and in their relationships.”
For women who aren’t yet pregnant, there are additional angles of the question to consider.
Drug impact on women’s fertility
Studies have not been done on the impact of SSRIs (the most commonly prescribed group of antidepressants) on natural, unassisted fertility in women. However, research has at least picked up some applicable data from studies of women going through IVF.
SSRI use is connected to more cancellations of IVF cycles (a very disheartening experience itself.) Generally, IVF cycles are called to a halt when a woman’s ovaries don’t adequately respond to ovulation medication. The question about any significant effects on pregnancy or birth rates following IVF depends on the study you read.
According to Susan Wallmeyer, L.Ac. of New York City, “It’s not clear from studies done so far whether decrease IVF success rates are from the underlying depression or from the medication.”
What is known: Depression can impact a woman’s hormonal balance, which may in turn affect her fertility, with or without fertility treatment.
Drug impact on men’s fertility
Recent studies have pointed to more definitive problems for men who take SSRIs. Sperm DNA fragmentation — which is associated with reduced fertility — is notable in this population. Paroxetine, or Paxil, in particular can slow the transport of semen, which then results in DNA damage. There’s some good news, though: other parameters used to determine a man’s fertility (volume, concentration, motility, and morphology) do not appear to be significantly altered by SSRI use.
Lowered libido
If you’re trying to conceive the old fashioned way, enjoying yourself and your partner in the process is beneficial, to say the least. But depression is notorious — in part due to that hormonal imbalance mentioned earlier — for deflating your drive. Unfortunately, so are most depression medications.
Crucial timing
Whether a woman is using IVF or other assisted conception techniques or going the natural route to get pregnant, it’s important for her to understand the possible impact of what she takes on the first trimester of pregnancy.
Different medications remain in the body for different lengths of time, so if you’re using medication of any kind and are TTC, consult with your prescribing health care practitioner about any known effects within the first few weeks of pregnancy. For optimal safety for your developing baby, you may or may not need to stop the use of some medications well before you conceive.
How to choose
For some, the safest option remains sticking with whatever has already been successful in keeping depression at arm’s length. Juliette Aiyana, L.Ac. of New York City, recommends staying the medication course if you experience the following:
- severe depression
- thoughts of suicide
- inability to work or go out of the house
- extreme mood changes
- lack of self-care and hygiene
- inflicting violence on yourself, such as with cutting, or on your loved ones
- drug or alcohol abuse
Wallmeyer makes clear that it’s not within her scope of practice to recommend a patient discontinue depression medication. But if she’s interested in pursuing an alternative to what’s been prescribed than she says:
The final decision should come about as a result of a discussion between the woman, her therapist, and her gynecologist or reproductive endocrinologist. The potential risks and benefits should be carefully weighed and discussed by a healthcare team the woman trusts and feels comfortable with, but in the end it has to be a decision the woman feels good about.
About Tracy Morris
I wear a lot of hats while spinning plates and true stories. In between taking care of myself and my family, I write about fertility and other health care topics. Most of my online time lately is spent at two very different places: FertilityTies.com and TrailerParkKarma.com. Perspective is everything -- my pre-teen reminds me daily.
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