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Depression and IVF

It is normal to feel sad and have low mood when you are going through a difficult time, and generally mood recovers once the difficult period has passed.  However, the continuation of low mood accompanied by emotions such as hopelessness and despair may indicate that depression has developed.  Depression alters how someone thinks and feels, and can interfere with the way someone functions in their daily life.

Depression is a complex illness, and is caused by a combination of biological, psychological, and social factors.  Rather than having one specific cause, it is thought that an interaction of factors including genetic vulnerability, brain chemicals, mood regulation, personality, stressful life events, and level of social support creates depression.

The process of going through IVF treatment is a psychologically distressing life event.  It is costly, often isolating, can be traumatic, and is an emotional rollercoaster.  For many people embarking on treatment, their struggles with infertility have already left them emotionally vulnerable and depleted.  It is not surprising therefore, that most studies examining the association between depression and fertility find a higher prevalence of depressive symptoms in men and women receiving infertility treatment than control groups.  The relationship between infertility and depression is complex, and no clear picture emerges from studies regarding cause and effect.  What is apparent, is that men and women undergoing IVF have an increased vulnerability to depressive symptoms.

How to recognise the signs of depression

Symptoms of depression vary between people and will impact people in different ways. 

Typical signs and symptoms include:

  • Feeling sad, teary or anxious
  • Feeling emotionally flat or numb
  • Feeling angry or irritable
  • Feeling hopeless or helpless
  • Pessimistic or self-critical thinking
  • Having thoughts of self-harm or suicide
  • Reduced motivation
  • Reduced enjoyment or pleasure
  • Loss of appetite or eating more than usual
  • Difficulty concentrating or remembering things
  • Changes in sleep (insomnia, waking frequently, sleeping a lot)

While most people experience some of these at different times, depression is diagnosed when a number of these symptoms occur together, are severe, occur often and don’t resolve over time.  If you are experiencing any of these feelings or behaviours visit your GP or mental health professional who can assess your symptoms, make an accurate diagnosis, and help you formulate a treatment plan.

Self-help strategies

Staying well, reducing stress levels, and participating in meaningful, enjoyable activities all contribute to the effective management of depression:

  • Stress Management:  Identify your sources of stress at work, at home, in your relationships.  Look at ways of reducing the pressure.  This might include reviewing the number of commitments you take on, learning to be more assertive about saying ‘no’. 
  • Lifestyle Changes – Adding exercise into your daily or weekly routine, reducing alcohol intake, making time for meaningful social connections, ensuring you have some downtime each day.
  • Support groups & internet forums – for some people, connecting with others who are going through similar experiences is enormously supportive. 
  • Relaxation Training

Treatment for depression

A treatment plan can successfully reduce or manage symptoms of depression, as well as target some of the causal factors.  Treatments typically include a combination of psychological therapy, medication, and lifestyle changes.

Psychological treatments

Psychological therapies, often called ‘talking therapy’, can help identify and change unhelpful thoughts and behaviours associated with depression, as well create strategies to manage symptoms more effectively.

Cognitive Behavioural Therapy (CBT)

CBT is considered one of the most effective psychological treatments for depression.  It is based on the premise that our thoughts (cognitions), feelings and behaviours are all interlinked.  It recognises that some thoughts and behaviours can increase the likelihood of depression,  or hinder recovery from it.   CBT helps identify and change those self-defeating thoughts and behaviours that contribute to depression.

For example, pessimistic thought patterns following a failed cycle might create an overall sense of failure, loss of confidence and feelings of worthlessness.   CBT helps you consider each of these thoughts objectively, and explore the evidence supporting these conclusions.  For example, what evidence are you using to measure your worth?  What is a more rational, fact-based, way of thinking?  What can you do to rebuild your confidence?

The behaviour part of treatment focusses on encouraging effective, goal-directed behaviour.  For example, your low confidence and motivation might be stopping you from attending a support group meeting, or seeing friends.  Creating an action plan that breaks down your goals into small, more manageable steps can help the situation feel less daunting. 

Mindfulness-based therapies

Studies have found mindfulness based therapies to be effective treatments for managing depression.  Unlike CBT, mindfulness techniques don’t try to change negative thinking patterns or actively reduce symptoms.  Instead, mindfulness strategies encourage non-judgmental awareness and acceptance of them.  For example, when you are caught up in the distress of a negative pregnancy test, try and focus on what the experience feels like.  Where in your body does it feel strongest? What does it feel like? Notice your thoughts, say each one out loud.  What happens when you stay present with your thought instead of pushing them away?  Although it seems counter-intuitive, staying in the moment with difficult thoughts and feelings can help change your response to them, and can increase your tolerance of them.

By increasing your awareness of your thoughts and feelings, Mindfulness-based therapies can also help you notice the early signs of depression returning, allowing earlier treatment.

Medication

Antidepressant medications can be very effective in the treatment of moderate to severe depression, and are often prescribed in combination with psychological therapy.  There are many types of antidepressant medication available and making the decision about which type of medication is best for each person depends on a range of factors including their medical history and their symptoms.

The effectiveness of antidepressants differs between people, and some people may need to try several different medications before they find one that works well for them.