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Can Treating Depression
Improve your Fertility?
by Gayle Peterson, LCSW, PhD
QUESTION: My partner and I
have been trying to conceive for over a year. I am also suffering
from depression, though I am not seeing a doctor or therapist
for this condition. I recently read that depression can affect
a woman's ability to conceive. Could this be true?
ANSWER: Research studies have
documented the correlation between stress and infertility since
the 1980s. The usefulness of such information has lagged because
the focus has been on vague definitions of anxiety, rather than
symptoms of depression. Recently, however, a refined look at
depressive symptoms and their impact on biology has been enlightening,
offering new hope and a mind/body approach that has proved to
be a heartening success for some women.
Consider these findings:
- Women
with a history of depressive symptoms reported twice
the rate of subsequent infertility (Psychosomatic Medicine,
1995,
vol.
57)
- Women with depression, when treated showed a 60 percent viable
pregnancy rate within six months, contrasting with
24 percent when depression went untreated. (Journal of American Medical
Womens Association, 1999, vol.54)
- Women who experienced depression following the failure of their
first in vitro fertilization (IVF), had much lower
pregnancy rates that their non depressed counterparts during their
second IVF cycle (Journal of Psychosomatic Research, 1993, vol. 37)
The research does not stop
there. Another study (Fertility Sterility, 1998, vol. 69) suggests
that because mind/body programs are effective for reducing negative
emotions that may impair IVF success, patients should be offered
such a program in conjunction with IVF.
What is the mind/body connection
between depression and fertility? Stress brought on by anxiety
and/or depression can alter immune function. We have all heard
about how the effects of depression can lower our immunity, making
us more vulnerable to colds and other viruses during emotionally
stressful periods. It is not such a stretch to discover that
a suppressed immune system can adversely affect our ability to
conceive.
Reproduction is one of our
most delicately balanced biological systems. Psychological stress
can affect our ability to get pregnant on multiple levels, including
inhibition of the hypothalamus that helps regulate hormonal levels,
or over activation of the hypothalamus which can change the pituitary
and adrenal responses. Since the pituitary regulates both how
much of a hormone is made and how much is released in the body,
its alteration can have dramatic effects on the hormonal balance
necessary for ovulation, fertilization, tubal functioning or
even successful implantation of the egg once it reaches the womb.
Infertility causes depression,
but what about prevention? The bad news is that even when women
have not been depressed previously, depression often occurs by
the second to third year of infertility and does not return to
normal levels until six years later. The good news is that researchers
have recently become proactive in studying the effects of treatment
for non depressed women BEFORE they get depressed.
A new study reported in Reproductive
Endocrinology (April 2000, vol. 73, issue 4), treated women who
were in their second year of infertility and not yet depressed.
The women who received group psychological interventions to stem
the tide of depression caused by infertility, had significantly
increased viable pregnancies compared to those who did not receive
preventative treatment for depression.
What can you do to increase
your chances of getting pregnant?
The following activities were
part of the treatment program that the women in the prevention
study received. Consider these as possible guidelines for a mind/body
approach to help you conceive whether or not you suffer depression
currently:
- Relaxation Techniques
Yoga, meditation, and visualization increase the body's resources
for achieving balance. Consider a daily meditation, yoga or
some other activity that calms the mind, but do not stop there.
I have had success in my own psychotherapy practice using a
body-centered hypnosis, which utilizes imagery, not only for
childbirth, but for infertility, too. The hypnotic effects
of visualization, coupled with relaxation can be a powerful
technique for communicating with the emotional center of the
brain (limbic system) that regulates hormonal activity and
balance.
Visualize your womb in a state of fertile health and
readiness. Make a relaxation tape, or have a professional
assist you in
creating an audiotape in which imagery and sound helps
you experience the sensation of conception and pregnancy.
(My
audiotape "Body
Centered Hypnosis for Pregnancy, Bonding and Childbirth" can
serve as an example of a visualization tape.)
- Emotional Expression
Releasing feelings is essential for deep relaxation. Do not
use visualization as a form of "positive thinking" alone.
Without releasing the "negative" feelings and
fears you experience, you will be likely to repress your
fears and
disappointment, resulting in depression.
Acknowledge your anger, grief, disappointment and fear. Share
your anxieties and feelings with others who may feel similarly.
Cry when you are disappointed and verbalize anger when it arises,
rather than hold it in. Releasing feelings will allow you to
feel better later, allowing you to be hopeful instead of hopeless.
- Cognitive Restructuring
Write your feelings in a personal journal, but with an eye
towards releasing your disappointment and continuing towards
your
desired goal. For example: When writing you may find yourself saying, "I
will never have a child". When you are tempted to express
your feelings as a negative projection of your destiny, remind
yourself that you are deeply disappointed, even angry. Stop short
of crystal ball interpretations that lead to depression. Acknowledge
the feelings rather than project them onto a futuristic event.
Instead, bring yourself back to reality and write the truth of
your actions, "I am doing everything I can to conceive."
- Group Support
Your desire to become pregnant and your inability to "make
it happen" may bring up emotions that surprise you.
It is common for women to harbor feelings of inadequacy
that effect
their self esteem and performance at work as well as their
marital
relationships. Anticipate your needs. Do not let these
feelings overwhelm you. Instead, use this opportunity to
get the support
you need from others, friends or professionals, to make
this an opportunity for learning and growth.
Supportive group therapy was a part of the treatment in the study
correlated with increased pregnancy. Sharing feelings can help
you feel less alone and allow you to work through discouragement.
These groups focused on the impact of infertility on self esteem,
marriage, family, friends and work. Find ways to share your feelings
rather than hold them inside.
Do not delay! Seeking treatment may not only help you conceive,
but may prevent an even greater spiral of depression that can
result from protracted infertility. Treating your depression
now may help stem a vicious cycle.
Gayle Peterson, MSSW, LCSW, PhD is
a family therapist specializing in prenatal and family development.
Dr.
Peterson practices in Grass Valley and can be reached at: (530)
346-6942, or through her website: www.AskDrGayle.com .She
is the author of An
Easier Childbirth, Birthing
Normally and her
latest book, Making Healthy Families. Her articles on
family relationships appear in professional journals and she
is an oft-quoted
expert in popular magazines such as Woman's Day, Mothering
and Parenting. She is a clinical member of The Association
for Marriage and Family Therapy and a Diplomat with the National
Association
of Social Work. She also serves on the advisory board for Fit
Pregnancy Magazine.
website: www.AskDrGayle.com
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