Depression Lowers Women’s Chances of Pregnancy

Women with severe depressive symptoms have a decreased chance of becoming pregnant, while their use of psychotropic medications does not appear to harm fertility a study by researchers from the Schools of Medicine and Public Health shows.

Published in the American Journal of Obstetrics and Gynecology, the study found a 38 percent decrease in the average probability of conception in a given menstrual cycle among women who reported severe depressive symptoms, compared to those with no or low symptoms. The results were similar, regardless of whether the women were on psychotropic medications.

Lead author Yael Nillni, an assistant professor of psychiatry at the School of Medicine and a researcher with the National Center for PTSD, Women’s Health Sciences Division of the VA Boston Healthcare System, said “Our findings suggest that moderate to severe depressive symptoms, regardless of current psychotropic medication treatment, may delay conception”.

She added that “current use of psychotropic medications did not appear to harm the probability of conception”. This is despite associations in prior studies between infertility and the use of antidepressants, antipsychotics or mood stabilizers among already infertile women.

Although the study does not answer why women with more depressive symptoms may take longer to become pregnant, the authors noted several potential mechanisms for future study. Depression has been associated with dysregulation of the hypothalamic-pituitary-adrenal axis, which may influence the menstrual cycle and affect the ability to conceive, for example.

Data for the study came from more than 2,100 women aged between 21-45 who planned their pregnancy, enrolled in a BU-led study known as PRESTO (Pregnancy Study Online) that investigates factors influencing fertility. Participants were asked to report their current depressive symptoms and psychotropic medication use, among many other factors. Overall, 22 percent reported a clinical diagnosis of depression in their medical histories, while 17.2 percent formerly used psychotropic medication, and 10.3 percent currently used psychotropic drugs.

Among the study’s secondary findings were that current use of benzodiazepines – sedatives used to treat anxiety and other disorders – was associated with a decrease in fecundability. Also, women formerly treated with antidepressants known as SSRIs (selective serotonin reuptake inhibitors) had improved chances of conception, regardless of depressive symptom severity. The authors speculated that former SSRI users could experience some long-term psychological or neurobiological benefits from past treatment that influence fertility. However, they also said the numbers of individual classes of medications were small, and further study is needed.

An estimated 10 to 15 percent of U.S. couples experience infertility. Past research suggests that women have a higher prevalence of depressive and anxiety disorders during their childbearing years than other stages of life.

BU School of Public Health (BUSPH) researchers on the study were: Lauren Wise, Kenneth Rothman and Elizabeth Hatch, professors of epidemiology; Amelia Wesselink, a data analyst on the PRESTO study; and Jaimie Gradus, assistant professor of epidemiology at BUSPH and assistant professor of psychiatry at the BU School of Medicine. Ellen Mikkelsen of Aarhus University, Denmark, also contributed.