Multiple small studies have demonstrated a link between infertility and psychological distress, reporting high rates of anxiety and depressive symptoms among women with infertility. These studies have evaluated psychiatric symptoms or psychological distress; however, less is known about the prevalence of more significant psychiatric disorders in this population. Â
Multiple studies have demonstrated an increased risk of poor neonatal adaptation associated with exposure to selective serotonin reuptake inhibitor (SSRI) antidepressants in late pregnancy. Results in the literature consistently indicate that about 25%-30% of infants exposed to SSRIs late in pregnancy manifest symptoms of poor neonatal adaption, including jitteriness, restlessness, increased muscle tone, rapid breathing. These symptoms are transient, resolving spontaneously with no specific medical intervention.
Most women undergoing infertility treatment experience increased anxiety. In a randomized clinical trial, researchers explored the effectiveness of acupuncture in diminishing anxiety in a group of women undergoing IVF. 43 patients undergoing IVF received either active acupuncture (n=22) or sham treatment (n=21).  Women with a history of psychiatric illness and those using antidepressants and/or anxiolytic drugs were excluded from the study.  Anxiety levels were assessed before and after treatment using the Hamilton Anxiety Rating Scale (HAS).Â
It is common for women experiencing infertility and undergoing fertility treatment to experience significant emotional distress. Many women, reasoning that their emotional health influences their physical functioning, worry that the stress and anxiety they experience in this context may hinder their ability to become pregnant.
Post-traumatic stress disorder (PTSD) occurs in approximately 10% of all women at some point in their lifetime. PTSD tends to occur more commonly in women during their childbearing years, yet we have only recently begun to look more closely at the incidence of PTSD associated with childbirth.Â
Given the prevalence of postpartum OCD and obsessive symptoms in women with postpartum depression, we should devote more time to this topic. This is an informative and well-written article by Alice Wolton on postpartum OCD in Forbes. In this piece, she mentions a recent study from Timpano and colleagues at the University of Miami where cognitive behavioral therapy (CBT) was used to prevent postpartum OCD.Â
Clinically significant anxiety symptoms are common during the postpartum period and frequently complicate the treatment of postpartum depression. Â Â While SSRIs are indicted for the treatment anxiety symptoms, especially when they co-occur with depression, many women may need to use a benzodiazepine for managing more severe symptoms of anxiety or insomnia.Â
![By Vera Kratochvil [Public domain], via Wikimedia Commons](https://womensmentalhealth.org/wp-content/uploads/2015/06/Mother_Kissing_Baby-320x202.jpg)
Serotonin (5-HT) is one of the neurotransmitters involved in mood regulation and has been implicated in the development of mood and anxiety disorders. Serotonin transporters (SERT) facilitate the transfer of serotonin into neurons; serotonin reuptake inhibitor (SSRI) antidepressants bind to these transporters and appear to exert their effect on mood by inhibiting the reuptake of serotonin and thus increasing the levels of this neurotransmitter at the synapse.
We previously reported that paroxetine, a selective serotonin reuptake inhibitor (SSRI), may affect sperm motility and may thus have a negative impact on male fertility. Many women who are planning a pregnancy question whether SSRIs and other antidepressants may affect fertility; this is obviously a particularly important issue for those who are having difficulty conceiving.
Few studies have focused on anxiety disorders in the perinatal period. While various studies have measured levels of anxiety or distress during pregnancy, most studies have relied upon self-report questionnaires to assess for anxiety. In contrast, few studies have used standardized diagnostic criteria to determine the prevalence of anxiety disorders in pregnant populations.  In a recent study, Buist and colleagues studied the prevalence and course of generalized anxiety disorder (GAD) in a prospectively ascertained population of pregnant women.
