The more I work in the area of fertility, the more I realize just how stressful it is to be told you are infertile and that conceiving a child will be difficult at best. It seems to me, that the unusual woman placed in this situation is the one who lives through it without experiencing any sort of depression.
Which is why this research caught my eye.
90 women diagnosed with infertility were randomly divided into 3 treatment gorups. One-third of them were given 10 sessions of behavioral therapy, including: relaxation training, and learning to eliminate negative automatic thoughts and dysfunctional attitudes. One third of the group was given 20 mg fluoxetine (Prozac) daily for 90 days. The last group did not receive any intervention.
And look at THIS! 79.3% of the women in the behavioral training group improved, compared to only 50% of those on medication. (Ten percent in the control group improved on their own.)
There are probably many reasons for these results. Here are a few that I thought of:
1. Behavioral therapy helped to extinguish the thoughts and behaviors that potentially contributed to the depression in the first place. Medication didn't.
2. When you talk to someone about how you feel, it often helps reduce the perceived magnitude of the problem. When you hold it all in, it only fuels the depression.
3. Behavioral therapy focuses you on the many things you CAN do to take care of yourself. It's an entirely different perspective than you may be getting from doctors who are telling you that you CAN'T get pregnant, you CAN'T etc., etc., etc.
Over the years in this specialty, I've seen many women externalize their depression. That is, they blame it on causes outside of themselves--"it's because I can't lose weight, it's because I can't have a baby, it's because I look like I do"…and so on. I won't argue, when depression takes its toll on your life, its consequences can fuel a vicious cycle. But to sell yourself on the belief that"if I just lose weight, if I could just have a baby, if I could just get some cosmetic surgery…" is an invitation to disaster. The line of women I've worked with who got what they thought they wanted, and still felt the same way that they did before, and who experienced major eating disorders, postpartum depression, and even suicidal thoughts on the back end, would stretch from my office to the county line.
Depression is a metabolic state, just like diabetes, just like high cholesterol, just like a skin rash. You'd never blame your rash on your relationship with your husband or convince yourself that if you could just get rid of your"muffin top" you wouldn't have diabetes…it's equally important to not make illogical leaps when it comes to depression.
What can be crucial with infertility, is treating depression at its source. Behavioral training helps to change your perception and response to events, which in turn reduces the levels of stress hormones circulating in your body. When that happens, you sleep better, you crave less carbohydrates, and the hormones you need to work in order to conceive, feel more like it's safe to come out and play.
A word about support groups. I've seen them do wonderful things, but I've also seen them focus the participants even more on the problem they have instead of on solutions for change. I was invited to attend a support group recently and it was impossible to get the participants to talk about anything other than their personal situations, and how horrible things were for them. I don't want to invalidate these feelings, but the purpose of a support group is to come away empowered, hopeful, and with an idea or two about how to make things better. So choose your support groups wisely.
If you're feeling depressed, go talk to someone about what you can do about it. Not what someone can prescribe for you, not what needs to happen in your life in order to make it go away, but what YOU can do to get back into balance.
Faramarzi M, Alipor A, Esmaelzadeh S, Kheirkhah F, Poladi K, Pash H. Treatment of depression and anxiety in infertile women: cognitive behavioral therapy versus fluoxetine. J Affect Disord. 2008 May;108(1-2):159-64.