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