Brief report
Treatment of depression and anxiety in infertile women: Cognitive behavioral therapy versus fluoxetine

https://doi.org/10.1016/j.jad.2007.09.002Get rights and content

Abstract

Background

Infertility is a stressful event that can give rise to psychological difficulties. Both psychotherapy and pharmacotherapy are well-established treatments for depression and anxiety. The aim of this study was to compare the effectiveness of cognitive behavioral therapy with fluoxetine in the resolution or decreasing of depression and anxiety in infertile women.

Method

In a randomized controlled clinical trial, 89 mild to moderate depressed infertile women (Beck scores 10–47) were recruited into three groups; cognitive behavior therapy (CBT), antidepressant therapy, and a control group. Twenty-nine participants in the CBT method received relaxation training, restructuring, and eliminating of negative automatic thoughts and dysfunctional attitudes to depression for 10 sessions. Thirty participants in the pharmacotherapy group took 20 mg fluoxetine daily for 90 days. Thirty control subjects did not receive any intervention. All participants completed the Beck Depression Inventory and Cattell Anxiety Inventory at the beginning and end of the study. X2 test, paired t-test, and ANOVA were used to analyze the data.

Results

The resolution of depression in the three groups was: fluoxetine group 50%, CBT 79.3%, and control 10%. The mean of the Beck scores at the beginning and end of the study was respectively: fluoxetine 23.2 ± 8.6 versus 14.3 ± 8.5(p < 0.001), CBT 20.1 ± 7.9 versus 7.7 ± 4.8 (p < 0.001), and control 19.8 ± 8.5 versus 19.7 ± 8.4 (p = 0.9). Although both fluoxetine and CBT decreased significantly the mean of BDI scores more than that of the control group, the decrease in the CBT group was significantly more than fluoxetine group. The CBT method decreased significantly the mean of the Cattell scores more than the fluoxetine and control groups, but the decrease in the anxiety mean scores of that fluoxetine group was no more than that of control group.

Conclusion

CBT was not only a reliable alternative to pharmacotherapy but also was superior to fluoxetine in the resolution or reducing of depression and anxiety of infertile women. Fluoxetine was superior to no therapy in the treatment of depression but not anxiety.

Introduction

Infertility is defined as 1 year of unprotected intercourse without pregnancy. Infertility has been characterized as creating of form of chronic stress that can rise due to a variety of psychological difficulties. Patients with infertility experience psychological symptoms similar to those associated with cancer, hypertension, and cardiac rehabilitation (Domar et al., 1993). Overall prevalence of psychological problems in infertile couples ranges between 25 and 60% (Seibel and Taymor, 1982). Infertility sometimes is accompanied by crises and emotional tensions such as depression, anxiety, interpersonal problems, suppressed anger, frustration, feelings of inferiority, and unconscious feelings of guilt (Kofman and Sheiner, 2005, Gox et al., 2006).

Cognitive behavior therapy (CBT) and medications are two major developments in the past 40 years concerning the treatment of depression. A recent comprehensive review of a meta-analysis of treatment outcomes for a variety of psychiatric disorders concluded that CBT is effective for adult unipolar depression, and furthermore, there was significant evidence for long-term effectiveness following cessation of treatment (Butler et al., 2006). Numerous studies suggest that psychotherapy, particularly CBT, is at least as effective as medication in the treatment of depression (Jacobson and Hollon, 1996, Mc Bride et al., 2006).

Despite widespread belief in the worthiness of CBT in the treatment of depression and anxiety, relatively few studies have evaluated the effectiveness of psychosocial interventions in the field of infertility. There have been no published, randomized controlled prospective trials to adequately compare the impact of group psychological inventions with pharmacotherapy on the promotion of mental health of infertile women. The following study will answer this question of whether CBT is a reliable alternative to fluoxetine in the treatment of depression and anxiety in infertile women.

Section snippets

Materials and method

A randomized controlled clinical trial was conducted in the Fatemeh Alzahra Infertility Center of the Babol University of Medical Sciences from September 2006 to June 2007. Women who had been trying to conceive for more than 2 years were recruited for this study. They were patients at the infertility center who did not decide to undergo fertility treatment until 3 months afterward. Eligible women who had more than 5 years education and were not currently practicing any relaxation techniques,

Results

The demographic characteristics of the study sample are summarized in Table 1. There were no statistically significant differences among the three groups in age, highest education level, and the duration of infertility. Also, there was no significant difference in causes of infertility among three groups. Infertility diagnoses in fluoxetine, CBT, and the control group were respectively: male factor (23%, 26%, and 24%), female factors (37%, 38%, and 34%), both female and male factors (25%, 24%,

Discussion

The first result from this data suggested that CBT was a reliable method for the resolution of depression and anxiety in infertile women. There are many studies that support this finding (Hasson et al., 2007). Terzioglu (2001) showed that couples who received daily information and support during treatment lowered their anxiety and depression scores and indicate higher life satisfaction than controls. Boivin (2003) reviewed a number of papers to determine whether psychosocial interventions

Role of funding source

Funding for this study was provided by the Research Center of Babol University of Medical Sciences. The Research Center had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Conflict of interest

All authors declare that they have no conflicts of interest.

Acknowledgments

The authors thank all the participants who attended this study. Also, the authors thank Mrs. Afshar for cooperation in the relaxation class and the midwives of Fatemeh Alzahra hospital who invited and encouraged women for attending in this study: Ghofrani, Asef, Mahoti, Firozpour, Golsorkhtabar, Rastegar and Rabian.

The authors thank Dr. Mostafazadeh for financial support of the project.

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