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This paper will seek to have an in depth look at depression with the special focus on the women facing infertility conditions. The paper tries to determine whether depression causes infertility and vise versa. It will take a broad look at the signs and symptoms of depression, the types, available treatment before narrowing down to women and especially the infertile women. To arrive at a reasonable conclusion, the paper will examine recorded cases of the infertile women who fought depression to conceive before looking at the available recovery avenues that both infertile women and other individuals facing depression can take to deal with this serious problem.

Literature Review

Depression can be defined in many ways, but majorly revolves around low moods feelings that one experiences on a day to day basis in life. Feelings that in one way or another interferes with one’s normal life activities, which may include but not limited to studying, eating, working, sleeping or just having fun. Many people have always related depression to sadness. This general understanding is however not an obvious case, since depression is more than sadness. Sadness may be said to be a normal reaction to life’s daily struggles and that not all those who are depressed are always sad. Therefore, a general understanding of depression may be described as a combination of a despair and emptiness which do not seem to go away any time soon in one’s life (Ainsworth, 2000).  This will mean that at some point one will be deprived of the normal life status which the person has always had.

Going back in history, depression, then referred to as melancholia, has been in existence since the time immemorial. Making reference to the Bible, King David and Job were under the affliction of depression. In the 19th century, depression was perceived to be the hereditary in nature. In the 20th century however, Freud linked the development of depression to guilt and conflict. John Cheever, on the other hand, regarded conflict and experiences with parents as the main cause of depression. In the 1970’s and 80’s, focus shifted from the cause to the effects of depression with several studies conducted on the possible remedies during this period (Ainsworth, 2000). This paper will seek to have an in depth look at depression with the special focus on women facing infertility signs and symptoms.

Signs and Symptoms of Depression

Before any claim of depression, one should have a clear knowledge of the common signs and symptoms. It is also advisable that people have a good understanding of themselves because the signs and symptoms are varied in different people. It becomes even trickier as some of the common signs and symptoms are part of the normal life and may not necessarily translate to depression. Precaution should therefore be taken in cases where this normal life common signs last for long; this may be an indication that one may be depressed without knowing. It is advisable that one seeks help before their situation gets out of hand (Marano, 2003).

Some of the common signs and symptoms of depression include; a feeling of hopelessness and helplessness, which leaves one convinced that there is no hope for better things to come, and that nothing can be done to salvage them from the current situation. Other reasons include losing hope in engaging in the daily activities, lose of the urge to take part in activities which traditionally formed part of ones everyday activities, such as visiting social places, carrying out one’s hobbies, engaging in past time activities or even having sex; amongst others depression simply makes one unable to feel the joy and pleasure. The drastic changes in appetite and body weight are the other symptoms. An experience of loss or gain body weight within a short duration of time, like 5% of body weight in one month should raise the suspicion of depression.

Experiencing the unexplained loss of appetite might also be an indication of depression. Changes in the sleeping trend of individual where people find themselves suffering from either insomnia; a situation where one wakes up early in the morning and stays awake without feeling sleepy again or hypersomnia, where one sleeps for abnormally longer hours with inability to engage in active activities. Uncontrolled anger where one manifests restlessness, agitation and get annoyed easily, loss of energy usually contributed by lack of eating, constant state of being tired, sluggish and laziness, which may be felt by one feelings of heavy body or even taking time to do simple chores and duties are some of the symptoms. Other symptoms such as self-loathing where people constantly blame themselves for perceived mistakes, unexplained increase in body aches and pains, which may include but not limited to headache, back ache, muscle strains, amongst others may also arise as a result of depression.

Problems with concentration that  are usually evident when one has a problem of staying focused for a reasonable period of time, being unable to make an important decision and may be having poor memory that incorporates being unable to remember important things that happened sometime in the distant and recent past. Exhibiting reckless behavior which are the out of thought, and makes one be perceived as an escapist. They might include but not limited to reckless driving, drinking, and indulging in drug and substance abuse.

After such a detailed look at the common signs and symptoms resulting from depression, it is now clearly evident that most people might have at one point or another been victims. The condition of being depressed, as light as it may appear in the above description, has resulted in the several deaths and is considered as a major cause of suicide in most parts of the world. The hopelessness and despair that comes along with depression makes the afflicted feel that committing suicide is the only way out of their otherwise desperate situations. The thought of committing suicide is a serious symptom of depression and should therefore be taken seriously. In order to avoid any possible commission of suicide, the person overheard talking about suicide needs to be helped immediately and if possible by a professional. In case an individual feels that the problem he is facing is overwhelming and permanent, it is of great significance to have it shared with those close. This will go a long way in helping reduce the pressure that may result into depression as the individual will learn that  hi current difficulties are also faced by other people who are not only willing to help, but also have much more serious problems. One is therefore advised to try as much as one can to seek help before the condition worsens.

Depression can be said to have appearances. It does vary depending on the person in question in that it looks differently in men, women, young and the old. In men depression is not easily evident as compared to women (Lois, 1992). Men tend to be more tolerant in a manner that the sense of hopelessness in them is not obvious. Being that they don’t show it, they manifest it in other ways which are mostly through symptoms such as being violent, full of anger, reckless and substance abuse among others. On the other hand, women are as twice as easily depressed as men. This is as a result of the hormonal factors especially when it comes to Premenstrual Syndrome (PMS) and Premenstrual Dysphonic Disorder (PMDD). As for the case of teenagers and adolescents, sadness is common but this is not to all. Here, irritability is the major symptom of depression. They develop behaviors such as hostility and grumpy. Aches and pains are also common in teenagers and adolescents. If these are not detected early enough, they might lead into several problems both at home and at school such as withdrawal, poor performance at school and lack of morale to study. It can also lead into cases of committing suicide or even homicide in the institutions where such teens learn.

In the elderly population, it may go unnoticed as most of the aged tend to talk of the physical signs than the emotional ones. They will always be heard complaining of experiencing back aches and headaches. Depression in the old age is majorly associated with deteriorating health situation, loss of family members like children, loss of the financial independence, lack of the societal support and loneliness in the homestead majorly after the children have moved to school or to their work places. For mothers, there is normally the depression that comes as a result of delivery. This is hormone controlled and occurs some few months after the delivery. It is known as a postpartum depression (Lois, 1992).  This type of depression usually goes away as the mother heals up, baked up with the joy brought by the presence of the baby. Mothers also get depressed when their babies are suffering from any time of Down syndrome making the child not to grow normally and as fast as is supposed to. This leaves the mother depressed especially when the child is on and off the hospital.

Types of Depression

By simply realizing or getting to know early enough that one is depressed if not all,  one needs to have more information concerning the type of depression one is suffering from. Different types of depression have the distinctive causes, symptoms and effects. Knowing the type of depression one is suffering from makes it easy to contain the symptoms and even get the most effective treatment. The different type of depression cuts across all the gender and ages, since everybody is vulnerable to getting either or a combination of them. Seasonal Affective Disorder (SAD) is a type of depression common among the young population. Other types of depression include; atypical depression which is a type of depression that overcomes a person to the level of the emotional paralysis, bipolar disorder also known as manic depession that is characterized by severe mood fluctuation and experiences a minimum of one episode of mania. There is also dysthymia and major depression, which show mood disorder including of chronic depression, but less severe signs (Parry and Haynes, 2008).

Treatment of Depression

For any condition or disease to be treated or put under control, it is of a great importance that their causal agent(s) are known both by the public and medical practitioners. Unlike the other forms of illnesses with specific medical cause, depression is more complicated since it does not have a specific medical cause. Professionals in this area believe that it is caused by an assortment of psychological, biological and social factors. For this, they argue that one’s lifestyle, relationship and ones coping up the techniques matter as much if not more so than genetics (Smith & Jaffe, 2011). Despite all these, certain risk factors make an individual more vulnerable to depression. Some of the causes and risk factors for depression area as highlighted herein include; loneliness, lack of the social support, recent stressful life experiences, marital or relationship problems, family history of depression, financial strain, early childhood trauma or abuse, alcohol or drug abuse, unemployment, health problems or chronic pain (Yonker & Steiner, 1999).

Going an extra mile of not only knowing but also understanding the underlying cause of an individual’s depression, is a sure way of overcoming the depression. For instance, if one has realized that the cause of depression is retrenchment from a job, the person should consider intensifying a job search or making a career change that exhibits job security and not resorting to the consumption of antidepressants. The same should be the case for depression from loneliness, where an individual is advised to go out and meet new people instead of going for therapy which would be very costly, but not achieving much. For such scenarios, the only solution is changing the situation that one is in (Smith & Jaffe, 2011).

Depression and Women

Depression has great impact on most if not all the areas of an individual’s everyday life. For women in particular, depression is more common. Data from the national mental health association indicates that about one in every eight women is likely to undergo depression in her lifetime. As earlier mentioned, women are twice more vulnerable to getting depression as compared to men and this is true across all racial, ethnic and economic divide (Marano, 2003).  To explain this, many theories have been developed to try and explain this fact of higher occurrence of depression in women than men. Many factors have been highlighted which range from biological, psychological to social causes (Michelle, 2008).

Biological Causes; this occurs majorly in women where there are hormonal causes of depression; some of these are discussed below. For instance, menstrual problems, when there is a hormonal imbalance at the time of the menstrual cycle causes some of the known symptoms of premenstrual syndrome (PMS) like bloating, fatigue and emotional reactivity. In many women, PMS is mild, but for other it is severe enough to interrupt their normal lives (Parry & Haynes, 2008). The other is pregnancy and infertility; the several hormonal variations that do occur in pregnancy can be contributors to depression, this is mostly in women whose pregnancies are already at risk from habits like smoking and excessive alcohol consumption. Other pregnancy related issues such as miscarriage, unplanned pregnancies as well as the infertility can also be the major causes of depression.

Psychological causes; this cause of depression in women occurs to those with a formed habit of focusing and altogether rehearsing the negative feelings (Parry & Haynes, 2008). Such depressed people occasionally cry in order to relieve the emotional tension, talking to fellow women to let them know of her situation and trying to figure out why she is depressed. The habit of rumination has, however, been found to be retaining depression rather than getting rid of it. On the contrary, men instead of ruminating try to distract themselves when under depression and for this reason, distraction is considered to reduce depression than rumination. Studies have shown that women are more prone to developing depression even in lower stress levels than men. This is because women produce more stress hormones than men, the sex hormone progesterone found in the female gender prevents the stress hormone from turning the silencing itself as is the case with men (Smith & Jaffe, 2011).

Depression and Infertility in Women

In order to give an exhaustive answer to the research topic, several research questions need to be answered. It is important that we find out whether depression causes infertility. It is clear that infertility can trigger depression, but the vise versa being true is still under the debate by experts in this field. According to the American Society for Reproductive Medicine (ASRM), there is little evidence on the correlation between stress and infertility in women. Despite the stress still not being proven to be capable of causing infertility, it is advisable that for one to be able to give birth successfully, precausion must be taken in order to manage stress. This was according to a report presented at a Cincinnati ASRM meeting in 1997.The report came from the uncontrolled research, that is, it never put into consideration those who did not participate in training and gave a result of 38% of the total women who completed  the stress management course conceived. Being that the research was uncontrolled, no meaningful statistical conclusion would be made from it, for instance, the obtained result was higher than expected (Smith & Jaffe, 2011).

In another study in which some women were infertile and kept to themselves, it was found out that pregnancy rates was double in women who handled depression by sharing with others, than those who decided to remain solitary and thus in the process lost their anger and guilt (Yonker & Steiner, 1999). Some research have indicated that one’s mood could have an effect on ovulation  and that increased levels of stress, does indeed cause fallopian tube spasm or decreased the sperm production. It has been proved beyond the reasonable doubt that counseling and support are of the great importance, but is not a surety for getting a baby (Corey et al 2006)).

Estimates of infertility in women range between 8% and 33% with the non-depressed being more fertile as compared to those who are depressed. Other causes of infertility are cases such as alcohol drinking, cigarettes smoking, use of antidepressants and the prior pelvic inflammatory diseases among others. An earlier study showed that women who had used antidepressants for a period of more than six months are three times more likely to be become infertile than those who had never used them. This case study was trying to find the correlation between the history of depression and infertility. Researchers contacted 339 female health survey respondents who had reported either a period of infertility that is in the ability to conceive after 12 months of unprotected sexual intercourse. Of the 58 women who reported the depression history symptoms prior to the period of infertility, 14 (24%) experienced infertility. Of the remaining 281women who did not show the symptoms of depression, only 38(13%) tested positive for infertility. Women undergoing depression were in most cases smokers, had higher or lower extreme body weight, or had a history of the sexually transmitted diseases. To control all these, other contributing factors such as inactive lifestyle, moderate alcohol, use and history of antidepressant use, those who had been depressed in the past were still almost twice as likely to report infertility in comparison to those who never reported depression (Menke & Stone, 2008).

From the survey reports which may be considered to be self-based that need to be replicated, it supports the school of thought that depressed women are less fertile as compared to non-depressed women. Other factors for instance, antidepressant use, smoking, alcohol use, STI’s are also contributors to infertility.  Health related habits like poor nutrition, decreased sexual activity also do contribute to infertility in women. Stress on the hypothalamic pituitary axis is also another contributor. It is important that clinicians also take note of the fact infertility can not only be caused by depression, but pre-existing depression can also lead to infertility.

It is also clear that infertility causes depression. This is because individuals would be asking themselves why they cannot bear their own children. For a woman, it would be more serious if her partner complains about the state of not being in a position to get pregnant. It would mean that they will never at any point of their marriage be at a position to raise their own children. With the notion from school that getting pregnant is easy, young women will be even more traumatized when they realize that they can no longer get pregnant which should be case for much older women. With the realization that the plans of conceiving is not taking the course a couple had planned for, they will now get into serious plans of using ovulation prediction kits and use of basal body temperature charts. In case these measures fail, the woman will feel more frustrated when the other option of helping solve her conception problem turns out not to be viable (Michelle, 2008). The end result would be feeling rejected by the society and spouse, and ending into the severe depression. Now that one has got into the state of being depressed, the next question that comes into mind is if there are side effects that treatment of infertility has with regards to the risk of depression and anxiety. It has been found that infertility and its treatment have acted to trigger both depression and anxiety. For women with the pre-existing histories of depression and anxiety and who have been under the constant medication, worsening symptoms brought about by the stress that comes with the process of treating infertility is inherent (Miller & Haynes, 2003).  The process proves to be a driving force of hopelessness and disappointments. The extent of depression and anxiety as a result varies from one person to another.

A study showed that women who presented for In Vitro Fertilization (IVF) were more depressed than a group of fertile women who were used as a control group for the study. Their depression was manifested in the form of the low self-esteem and less confidence. Symptoms such as hostility and anxiety scores were higher in women at the time of embryo transfer that is before pregnancy test, than at the first or second visits which were also before the transfer (Flaws, 1999: Lois, 1992).  After failed IVF, the women again showed a decline in the self-esteem and an increase in depression related to pre-treatment levels. A comparison between women undergoing repeated IVF cycles with those who are taking the cycle for the first time showed an increase in the depressive symptoms (Parikh et al, 2002).

The treatment of depression should be done concurrently with the treatment of infertility since there is evidence that depression may have negative effect on the success rates of infertility treatment. It is found that stress may play a role in early pregnancy loss. This can be explained by having stress hormones such as Cortisol being able to affect the uterine circulation which will in turn affect implantation and placental function. Therefore, interventions which aim at reducing the stress level will help in improving the outcomes. A demonstration by researcher Alice Domar and her colleagues showed that the group based psychological interventions that aim at stress reduction through the relaxation techniques lead to higher rates of conception (Miller & Haynes, 2003).  Many women who are undertaking the fertility treatment are likely to be reluctant in taking medication, but they may be appropriate for managing symptoms of anxiety and depression. In case the medication taken are for milder symptoms of anxiety and related to uncertainty of IVF process, then it is possible to discontinue the medication once the pregnancy is documented and the IVF process is completed (Parikh et al. 2002.)

A Case of a Woman Who Became Depressed Due to Infertility

The case study focuses on a woman who decided to share her experience of depression, which was as a result of infertility with a Fox News journalist. The woman says that she got into a relationship with a man who was not with the idea of bearing children. Despite the fact that she always wanted to have children at one point in her life, the husband was not for the idea. This made her worried because this would mean a disaster for her and the marriage since her dream of being a mother was going to be shuttered.

After the incident, the woman decided to break from the marriage and wait for the right partner whom would be willing to have a family. It took long but she never gave up on her search. By the time she was 37 years old, she came across a man who was 42. She tried conceiving even before the engagement. She never conceived even after their wedding and because of this they decided to go for the fertility clinic. The checkup was done with nothing to record. After the tests, the couple decided either to try a few months of a drug called Clomid, or the woman was to go for operation to find out whether she had Endometriosis. After the consultation, she decided to go for the Clomid since her friend had tried it earlier and got pregnant in the first cycle. She took the drug for three months without seeing the fruit she expected and opted out since the drug was strong and therefore not safe for a long term use (Foxnews.com).

After the stop of Clomid, she decided to quit the fertility clinic since she believed they were mostly concerned with pharmaceuticals and surgical remedies. She was not for the idea to go for endometriosis as she never had experienced most of its symptoms. With an example of a 42 year old woman who had successfully delivered twins in her third try of IVF, who had never imagined that she would conceive. At this point, she was very depressed due to the fact that she had essentially gone through much of mourning and acceptance of loss at an earlier point in her mid-thirties. Because of all these and the depression that come with, the couple thought of becoming foster parents or even adopting a child (Foxnews.com).

At around the age of forty and a half, she decided to make some lifestyle changes such as having an outdoor walk, to change from the habit of staying indoors most of the time while clued to her computer. Another problem that was more serious was the habit of smoking, which she had developed since she was 17 years. A change which she incorporated was in her diet. She started eating more greens and legumes. With the continual of this practice, she became even healthier, but all these changes and improvements she was doing were not to get pregnant. With these improvements now turning into a habit, she started experiencing a change in her moods and energy level and to add on her monthly period became even more regular with no more symptoms of PMS.

The miracle as she termed it came seven months later after the initiation of these improvements. Nine months later she gave birth to a healthy baby. She asserted that she was not sure about which of the changes she had made in her lifestyle contributed greatly to the conception, but she believes all of them were very helpful (Foxnews.com). Her story clearly provides the evidence of the relationship between infertility and depression and in as much as it is not a research case study; it does underscore the significance of getting rid of depression for a successful conception. Depression triggered by infertility can be manageable, stating that infertility brings with it the ability to be able to turn such dark reality of being infertile into a positive catapult, for things that you might never have imagined or desired. One of coming back to normalcy is by accepting the situation and sharing with friends the problem for emotional stability before visiting a medical practitioner for the further advice. Once the infertility is treated, the depression will be over owing to the fact that the cause is no longer a problem.

Recovery from Depression

In order for one to recover from depression, several measures need to be put into practice. Some of them may include learning to recognize and accept ones emotions. This would start by first developing the emotional awareness. Just as with the case of causes and symptoms, depression is manifested differently in different people, and so are the ways of feeling better. In case depression is suspected to be taking its toll on an individual, it is highly advisable that several treatment options be explored. This is so because not one treatment can be considered to work for all cases of depression. In most cases, the best proven approach entails a combination of the lifestyle changes, social support, emotional skills building and professional help (Lois, 1992).

It is equally good to ask for help and support from the people around. It is advisable that one be open and discuss with others, preferably family members, about what one is going through. Whenever one feels hopeless and helpless, which are the major symptoms of depression; it does not mean that one is weak or that one cannot change.

Making lifestyle changes has also proved to be fruitful as evident in the above case where the afflicted woman was able to conceive after changing and making the significant improvements in her lifestyle. Making these changes might prove to be difficult, but one has to try and put more effort towards their achievements. Some of the lifestyle changes that one needs to inculcate, include but are not tied to encouraging supportive relationships, getting regular and good body exercise and sleep, having healthy well balanced meals that boosts the person’s mood, coping and effectively managing stress, practicing relaxation techniques, and evading negative thoughts (Paul et al, 2011). Build-up of the emotional skill, which may involve managing stress and balancing emotions, is very critical. Generally, learning how to recognize and express ones emotions makes one even more resilient. Seeking the professional advice will also enable one to choose measures which are likely to work best for one particular situation and need. There are many effective treatments for depression which include therapy, medication and alternative treatments. With the help of a professional, making a decision on which method to go for will be easier.

Many people, especially infertile women usually like to know whether the use of antidepressant is right or wrong. Experts advise that medication can relieve the symptoms of depression in some people, but they aren’t a cure and thus come with side effects after their use that may end up harming patients and erasing the slim chance of conception in these women (Miller & Haynes, 2003). Learning the facts about antidepressants leaves one with the task of making an informed and personal decision about whether medication is right for them. This comes after weighing out their benefits against the risks of antidepressants (Crawshaw & Balen, 2010).

Conclusion

Depression is manifested as a consequence of infertility in women. This is, however, not straight forward for many women who are trying to conceive, because they are already depressed by the time they realize that they have infertility problems. It is extremely important that women deal with their depression conditions before aggressively trying to conceive. This should be the case not only for the reason that depression is causing infertility, but also to eliminate the depression condition for other medical reasons. It is also noted that infertility can cause depression. The inability to conceive usually leads to prejudice in the society where the childless woman is looked down upon by the other members of the society. This family and society pressure leads to depression that when not handled promptly may result into much more complicated medical conditions. One of the most helpful methods against the depression includes a combination of antidepressants, therapy and support of the society. Making lifestyle changes is also fruitful means as evident in the case of the 37 year old afflicted woman who was able to conceive after changing and making the significant improvements in her lifestyle. The combination of all these methods will increase the potential of  person’s ability to deal  effectively with depression. Once a woman realizes that she has a depression, an effort should be made to contact a health care service provider immediately who may in turn refer the patient to a qualified psychiatrist. In situation where such conditions are left untreated, depression can result in work loss, physical ailments, strained relationship and death. Lack of treatment of depression for a longer period also leads into social problems such as divorce, inability to hold a job and even suicide. 

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