Assisted reproduction and risk of depressive relapse: considerations for treatment

At present, there is a lack of systematic data regarding the risk of relapse of psychiatric disorders in women undergoing infertility treatment. Clinicians would benefit from a systematic study of the biological sequelae of stress and the clinical implications for women with histories of depression or anxiety disorders undergoing treatment for infertility. Women with histories of major depressive disorder may be vulnerable to the stress involved in the process of assisted reproduction, and treatment changes during this time in anticipation of a pregnancy may affect relapse rates.

We have highlighted the elements important to the care of women undergoing assisted reproduction with histories of depression in the following case report and review of the relevant literature.

No clinical guidelines currently exist for prevention of depressive relapse in women seeking infertility treatment. Due to concerns about medication exposure during a potential pregnancy, many women will avoid antidepressants.

The profession needs to identify women at risk of depressive relapse and create evidence-based treatment guidelines for their management. Similarly, among patients who may be pregnant, providers should monitor mood, psychotherapeutic approaches, and collaborative decision-making about medication use carefully.