Effects of depression pharmacotherapy in fertility treatment on conception, birth, and neonatal health: A systematic review.
OBJECTIVE
While antidepressant medications are currently used during conception, gestation and post-partum, considerable uncertainty exists regarding the benefits and harms conferred to mothers and their offspring. A significant body of evidence has focused on antidepressant use during pregnancy and post-partum. However, it is difficult to know if this translates to specific populations. Women receiving treatment for infertility are especially vulnerable to symptoms of depression and adverse perinatal outcomes. This systematic review aimed to determine the effects of antidepressants taken during the perinatal period by women receiving fertility treatment on conception, birth, and long-term maternal and child health outcomes.


METHODS
We searched MEDLINE, EMBASE, CINAHL, the Cochrane Library, PsycINFO, ProQuest Dissertation & Theses, and Pubmed databases from January 1950 to November 2015. Articles were screened for inclusion independently by two reviewers. Studies were included if they enrolled women of reproductive age exposed to pharmacotherapy for depression and infertility at any point during the perinatal period.


RESULTS
A total of 8587 unique citations, and 83 full-text articles were reviewed. Of these, two randomized controlled trials and two retrospective chart reviews were included in the narrative synthesis. While most studies reported on assisted reproduction processes and birth outcomes, none examined long-term impacts on maternal-child health. The few included studies did not find that antidepressant use by women receiving fertility therapy impacted gamete quality or pregnancy success.


CONCLUSIONS
Currently, no studies address whether pharmacotherapy for the treatment of depression in women undergoing assisted reproduction affects their health or that of their offspring long-term. It appears that much like antidepressant use in fertile women, there are risks associated with both antidepressant use and untreated depression. Decisions regarding the treatment of depression should be made taking into account clinical presentation and illness severity. Given the complexities of conducting research in this population, future research should attempt to leverage health registry data, to increase sample sizes and follow mothers and children longitudinally.
Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; School of Nursing, McMaster University, Hamilton, ON L8N 3Z5, Canada. Electronic address: sele.akioyamen@mail.utoronto.ca.
Leo E
LE
Akioyamen
College of Health Professions, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA; Faculty of Science, McMaster University, Hamilton, ON L8S 4M1, Canada. Electronic address: minhash@mcmaster.ca.
Hersimren
H
Minhas
Department of Obstetrics & Gynecology, McMaster University, Hamilton, ON L8S 4K1, Canada. Electronic address: hollow@mcmaster.ca.
Alison C
AC
Holloway
Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada; Division of Women's Mental Health, Women's College Research Institute, Toronto, ON M5G 1N8, Canada. Electronic address: valerie.taylor@wchospital.ca.
Valerie H
VH
Taylor
Arthur Labatt Family School of Nursing, Western University, London, ON N6A 5C1, Canada. Electronic address: oakioyam@uwo.ca.
Noel O
NO
Akioyamen
School of Nursing, McMaster University, Hamilton, ON L8N 3Z5, Canada; Diabetes Care and Research Program, Hamilton Health Sciences, Hamilton, ON L8N 3Z5, Canada. Electronic address: dsherif@mcmaster.ca.
Diana
D
Sherifali
D000328:Adult; D000928:Antidepressive Agents / Q000494:pharmacology*; D003863:Depression / Q000188:drug therapy*; D003865:Major Depressive Disorder / Q000188:drug therapy*; D005260:Female; D005306:Fertilization; D006801:Humans; D000068104:Infant Health; D007231:Infant, Newborn; D008297:Male; D036801:Parturition; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic; D027724:Reproductive Techniques, Assisted; D012189:Retrospective Studies
D000928:Antidepressive Agents
Antidepressant; Assisted reproduction; Depression; Fertility; Infertility; Systematic review