Treatment of depression and anxiety in infertile women: cognitive behavioral therapy versus fluoxetine.

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. Chi2 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.