title: Depression, anxiety, and psychotropic medication use and fecundability.
abstract: The literature regarding the associations between depression, anxiety, and fecundity is inconsistent. While cross-sectional studies suggest that depression and/or anxiety may adversely affect fecundity, the sole cohort study showed only a small association.
  
  
  
  We sought to evaluate the association of self-reported depressive symptoms, self-reported diagnoses of depression and anxiety, and psychotropic medication use with fecundability in a prospective cohort study.
  
  
  
  Data were derived from Pregnancy Study Online (PRESTO), an Internet-based preconception cohort study of couples attempting to conceive in the United States and Canada. At baseline, female participants completed a survey that assessed demographic information, history of physician-diagnosed depression and anxiety, self-reported depressive symptoms (assessed by the Major Depression Inventory), and use of psychotropic medications. Women completed follow-up surveys every 8 weeks for up to 12 months or until reported conception to assess changes in exposures and pregnancy status. We estimated fecundability ratios and 95% confidence intervals using proportional probabilities regression models. The analysis was restricted to 2146 women who had been attempting to conceive for ≤6 cycles at study entry.
  
  
  
  Severe depressive symptoms at baseline, regardless of treatment, were associated with decreased fecundability compared with no or low depressive symptoms (fecundability ratio, 0.62; 95% confidence interval, 0.43-0.91). The fecundability ratio associated with a 10-unit increase in Major Depression Inventory score was 0.90 (95% confidence interval, 0.83-0.97). Women who reported moderate to severe depressive symptoms and had never received psychotropic medications (fecundability ratio, 0.69; 95% confidence interval, 0.48-0.99) or who were currently being treated with psychotropic medications (fecundability ratio, 0.72; 95% confidence interval, 0.44-1.20) had decreased fecundability relative to women who had no/mild depressive symptoms and had never used psychotropic medications. Former users of psychotropic medications had increased fecundability regardless of the presence of no/mild depressive symptoms (fecundability ratio, 1.22; 95% confidence interval, 1.06-1.39) or moderate to severe depressive symptoms (fecundability ratio, 1.18; 95% confidence interval, 0.80-1.76).
  
  
  
  We found an inverse association between depressive symptoms and fecundability, independent of psychotropic medication use. Use of psychotropic medications did not appear to harm fecundability.
authors.affiliation: National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA. Electronic address: yael.nillni@va.gov.
authors.forename: Yael I
authors.initials: YI
authors.lastname: Nillni
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, Boston, MA.
authors.forename: Amelia K
authors.initials: AK
authors.lastname: Wesselink
authors.affiliation: National Center for Posttraumatic Stress Disorder, Women's Health Sciences Division at VA Boston Healthcare System, Boston, MA; Department of Psychiatry, Boston University School of Medicine, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA.
authors.forename: Jaimie L
authors.initials: JL
authors.lastname: Gradus
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, Boston, MA.
authors.forename: Elizabeth E
authors.initials: EE
authors.lastname: Hatch
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, Boston, MA; RTI Health Solutions, Durham, NC.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Rothman
authors.affiliation: Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Mikkelsen
authors.affiliation: Department of Epidemiology, Boston University School of Public Health, Boston, MA; Slone Epidemiology Center, Boston University, Boston, MA.
authors.forename: Lauren A
authors.initials: LA
authors.lastname: Wise
mesh_terms: D000328:Adult; D001007:Anxiety / Q000188:drug therapy; D003863:Depression / Q000150:complications* / Q000188:drug therapy; D005260:Female; D005298:Fertility / Q000187:drug effects; D006801:Humans; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000009:adverse effects / Q000627:therapeutic use*; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires
chemical_list: D011619:Psychotropic Drugs
keywords: anxiety; depression; fecundability; psychotropic medication