title: The effect of antidepressants on fertility.
abstract: Information on the effects of different pharmaceuticals on fertility is sparse. Human and animal models indicate that antidepressant use could have a negative effect on fertility through alteration of levels of the neurosteroid, allopregnanolone.
  
  
  
  The objective of this study is to assess the effects of antidepressants on the natural fertility in women.
  
  
  
  A secondary analysis of data from Time to Conceive, a prospective cohort study, was conducted. Women ages 30 to 44 years without a history of infertility, early in their attempts to conceive, were followed with standardized pregnancy testing until pregnancy was detected. Medication use was assessed at enrollment, daily for up to 4 months, and then monthly. For this analysis, discrete time regression models were created to calculate the association between antidepressant use and fecundability. Potential confounders-age, body mass index, caffeine, alcohol use, and education-were included in all models.
  
  
  
  Ninety-two (9.6%) of 957 women reported antidepressant use while attempting to conceive. Women taking antidepressants were more likely to be non-Hispanic Caucasian (91% vs 75%, P < .01) and to consume alcoholic beverages (74% vs 61%, P < .01). Antidepressant use at enrollment had an adjusted fecundability ratio (FR) of 0.86 (95% confidence interval [CI], 0.63-1.20). However, time-varying analyses suggested that antidepressant use in a given cycle is associated with a reduced probability of conceiving in that cycle (adjusted FR, 0.75; 95% CI, 0.53-1.06). After adjusting for history of depression or restricting the analysis to women who reported a history of depression, the association between antidepressant use and decreased fecundability remained [adjusted FR, 0.66 (95% CI, 0.45-0.97) and (adjusted FR, 0.64; 95% CI, 0.43-0.94), respectively].
  
  
  
  Our data suggest that antidepressants may reduce the probability of a woman with a history of depression to conceive naturally. Future studies are needed to differentiate the extent to which this association is due to the antidepressant itself versus the underlying depression.
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina.
authors.forename: Marianne M
authors.initials: MM
authors.lastname: Casilla-Lennon
authors.affiliation: Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Samantha
authors.initials: S
authors.lastname: Meltzer-Brody
authors.affiliation: Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina. Electronic address: asteiner@med.unc.edu.
authors.forename: Anne Z
authors.initials: AZ
authors.lastname: Steiner
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000009:adverse effects / Q000494:pharmacology* / Q000627:therapeutic use; D003866:Depressive Disorder / Q000188:drug therapy*; D005260:Female; D005298:Fertility / Q000187:drug effects*; D005306:Fertilization / Q000187:drug effects*; D006801:Humans; D007247:Infertility, Female / Q000139:chemically induced*; D011247:Pregnancy; D018873:Pregnancy Rate; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000928:Antidepressive Agents
keywords: antidepressants; depression; fecundability; fertility
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