Can Antidepressants Affect Your Fertility?
Depression is estimated to impact 21 million adults in the United States alone, which is about 8.4% of all U.S. adults. So, whether you personally have experienced depressive episodes or not, chances are, someone you love is or has suffered from depression. Although most couples having trouble getting pregnant can tell you, the incidence of depression rises significantly in couples suffering from infertility.
Unfortunately, many couples who are suffering from infertility-related depression are often less likely to seek out help for their condition. Part of the reason they may not seek support can be related to the fact that some may think their depression is situational and potentially temporary. Some, on the other hand, may not seek help due to fears pharmaceutical interventions, like anti-depressants, could worsen their ability to conceive. So, let’s talk about the research and what you need to know about addressing your depression during your fertility journey.
The first, most important point we must address is the elephant in the room. Although depression can be an extremely isolating condition, YOU ARE NOT ALONE. Over 21 million Americans are reported to be suffering from some form of depression. This number is also an estimated number and most likely does not take into account the cases that are undiagnosed and untreated. Depression can happen, and yes, even if you have the “perfect” life, struggling to conceive, experiencing a miscarriage and, or completing rounds of failed fertility treatment, can cause depression in even the “happiest” of couples. And although you may be struggling to consider talking to your doctor because you are worried that medication is your only option, please note that asking for help is an important way to support both your physical and mental health both during your fertility journey as well as pregnancy. In fact, untreated depression in pregnant women has been associated with a variety of detrimental health concerns for both baby and mothers. Babies born to women with untreated depression are at risk of premature delivery, low birth rate and intrauterine growth restrictions. We also see the consequences of untreated maternal depression impacting children throughout childhood including increasing impulsivity, maladaptive social interactions, cognitive, behavioral as well as, emotional difficulties to name a few. In other words, if you are suffering from depression during preconception, this depression may continue and could worsen during pregnancy, leading to a variety of health related concerns. Increased hospital admissions and pregnancy complications including preeclampsia have also been associated with untreated maternal depression.
So, although you may be thinking about your exercise routine, the supplements you are taking and the food you are eating to optimize your fertility, one of the most important aspects to address during your fertility journey is your mental health. Seeking adequate support and guidance from a medical professional is extremely important. Although there is an assumption that medication is the only option when treating depression, the reality is some of the most successful providers helping patients overcome depression have found that lifestyle, counseling and dietary modifications should all be considered alongside pharmaceutical interventions.
So, what if you have recently been prescribed an antidepressant during your fertility journey, could this be impacting your ability to get pregnant? The reality is, researchers have shown more disadvantages from untreated maternal depression than the use of antidepressants both during preconception and pregnancy.
The most commonly prescribed antidepressants generally fall into three main categories: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs) and selective serotonin noradrenaline reuptake inhibitors (SSNRIs). Although pharmaceutical interventions like anti-depressants may be recommended in your particular case, it is important to note that many antidepressants are known to have a variety of side effects, including nutrient deficiencies. This is where being an informed consumer allows you to make the potential adjustments needed while also addressing your depression. Some of the common nutrient deficiencies experienced by those using antidepressants include deficiencies in Vitamin B3 (Niacin), Folate, Coenzyme Q10, Calcium and Vitamin D. Many of these nutrients are essential for embryo development and may require you to consider additional supplementation.
Niacin (Vitamin B3)
Niacin is involved in more than 500 intracellular reactions. This important water-soluble vitamin, when deficient, can lead to neuropsychiatric as well as neurodegenerative disorders. Many antidepressants can inhibit the activity of indoleamine 2,3-dioxygenase (IDO) , an important enzyme involved in the synthesis of niacin. Now, before you start supplementing with additional niacin, always consult with your doctor first because taking high doses of niacin can lead to a “niacin flush”. A niacin flush is a common side effect seen in patients taking high doses of niacin supplements and can lead to flushing of the skin which may be accompanied by an itching or burning sensation.
Folate is an extremely important nutrient necessary in early fetal development and is involved in the development of the neural tube. Deficiencies in folate can be associated with major birth defects including anencephaly and spina bifida. Interestingly, researchers have found that although anti-depressants may not directly cause a folate deficiency, a variety of studies, including randomized controlled trials have found a link between low serum folate levels and depression. Which means, that if you are suffering from depression, evaluating your folate levels (best done with a simple blood test), is an important first step in addressing your depression. Researchers have also found that in subjects commonly resistant or non-respondent to antidepressant therapy showed significant improvement and much greater drug efficacy when they were given supplemental folate alongside their antidepressant. You likely have heard about the importance of taking folic acid in pregnancy and preconception, but ideally we generally recommend our patients make sure their prenatal contains methyltetrahydrofolate, the active form of folate rather than the synthetic, cheap and often poorly absorbed form of folic acid. Check the back of your prenatal ingredient list to make sure it contains methyltetrahydrofolate. Our favorite high quality prenatal can be found here.
If you have been trying to conceive, chances are, you have heard about Coenzyme Q10. Coenzyme Q10 has been shown to potentially improve ovarian response in women with poor ovarian reserve. Other studies have shown that CoQ10 supplementation may help improve egg quality often associated with infertility. Unfortunately, tricyclic antidepressants have been shown to potentially inhibit coenzyme Q10-dependent enzymes, impairing mitochondrial function and increasing oxidative stress. Although these studies were done often in vitro or in animal studies, it is important to consider CoQ10 enzyme supplementation, especially if you are taking tricyclic antidepressants.
Daily physical activity is an extremely underrated therapy to combat depression. In fact, researchers have found that exercise alone could be an effective way to reduce mortality associated with depression as well as an important underused treatment option for treating the symptoms of major depression. When it comes to incorporating exercise into your daily life, it is important to remember that, especially if you are experiencing depression, chances are, you won’t be internally motivated to exercise each and every day. This is where relying on motivation is often the biggest mistake many people make. Instead, consistency is one of the most important ways to support daily movement. Be consistent with when and how you move your body each and everyday! We often recommend taking just five to ten minutes to carve out time in your calendar to schedule your daily workouts. Most of our patients are able to stay consistent when they schedule their workouts in the morning, ideally at the same time everyday. Trust me, I get it, there will be days when you would rather stay in bed or have eight million other things you can be doing, but the truth is, if you carve out time every single day, slowly but surely exercise will become a not negotiable similar to how many people feel about their morning coffee. Try not to put the pressure of exercise as a form of physical weight loss but instead focus on moving your body for your mental health. If you can move your workout outside, even better! Researchers have found that adequate Vitamin D status can have a significant impact on mood related disorders, including depression. Also remember that exercise doesn’t have to involve an hour to an hour and a half of your time. Instead aim for 15-20 minutes each and every day. This can include a morning walk around the neighborhood, a quick at home workout, or joining a fun yoga class you love meeting your girlfriends at. Make exercise fun and do something you enjoy!
Using Food as Medicine
Did you know what you eat can impact the severity of your depression? Yep, that’s right, researchers have found several nutrition, food and dietary compounds may not only be involved in the onset and maintenance of depressive disorders but also in the severity of depressive symptoms. In other words, what you eat really does matter. Avoiding skipping meals, highly processed foods, sugary drinks and limited high quality fruits and vegetables can also impact your blood sugar balance throughout the day and impact your mood. Making your meal times a priority, putting your phone away and being an active participant in your food experience is an important first step. If spending three hours in the kitchen doesn’t sound like your cup of tea or isn’t a reality in your current busy lifestyle, opt for a meal delivery service to help you access the high quality nutrition you need to support your mood and to optimize your fertility. Aiming for an anti-inflammatory diet with high quality protein, fresh vegetables and healthy fats is a great way to support your mood! Some of our favorite meal delivery services include: Sunbasket, Sakara and Purple Carrot.
About the Author: Meet Dr. ZenAlissia Zenhausern- Pfeiffer, NMD, FABNE, (commonly known by her patients as Dr. Zen), is a licensed naturopathic doctor board certified in naturopathic endocrinology and the founder of NMD Wellness of Scottsdale, a premier naturopathic medical practice that focuses on helping women to take a proactive approach to their hormone and fertility health. Dr. Zen has been featured as a lead expert in Forbes, Shape Magazine, and Instyle and is deeply passionate about bridging the gap between traditional and natural medicine in the world of fertility. She works with a variety of hormone related issues including PCOS, endometriosis and unexplained infertility. Her goal is to help more women get back into the driver’s seat of their own health to make lasting transformational changes to their health to bring more cute and adorable babies into this world. Read More About Dr. Zen...