Course and predictors of depressive relapse during IVF

IVF期间抑郁症复发的过程和预测因素

• 批准号: 8384410
• 负责人: LEE S COHEN
• 金额: $ 24.86万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-08-01 至 2014-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8384410
• 关键词: Age; Antidepressive Agents; Area; Biological; Biological Markers; Clinical; Clinical Management; Data; Embryo Transfer; Evidence based treatment; Exposure to; Fertilization in Vitro; Funding Opportunities; Gonadotropins; Grant; Guidelines; High Prevalence; Hormonal; Hydrocortisone; Infertility; Inflammation; Intervention; Investigation; Light; Maintenance; Major Depressive Disorder; Medicine; Menstruation; Mental Depression; Moods; Neurosecretory Systems; Outcome; Participant; Pattern; Phase; Pregnancy; Pregnancy Tests; Procedures; Psychotherapy; Public Health; Rattus; Recording of previous events; Recurrence; Relapse; Relative Risks; Research; Retrieval; Risk; Risk Factors; Salivary; Science; Stress; Symptoms; Time; Woman; Women' s Health; aged; assisted reproduction; base; biological adaptation to stress; clinical decision-making; depressive symptoms; egg; evidence based guidelines; experience; hypothalamic-pituitary-adrenal axis; inflammatory marker; novel; prospective; reproductive; resilience; stressor

DESCRIPTION (provided by applicant): This revised proposal is an R21 application for the ORWH Funding Opportunity Announcement "Advancing Novel Science in Women's Health Research (ANSWHR)" (PAS-10-226). Major depressive disorder (MDD) is prevalent in women of reproductive age, and the course of MDD across infertility treatment and implications for clinical management have not previously received systematic study. At this time, clinicians do not have evidence-based treatment guidelines on which to rely in order to advise women with histories of MDD who plan in vitro fertilization (IVF) or other assisted reproductive procedures. The context of infertility treatment is an intriguing and clinically compelling setting for the stuy of the biological stress response, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, and risk for major depression. The aims of the study are: 1) to delineate the clinical predictors of depressive relapse in women with histories of depression across a period of six months while they are undergoing IVF including: antidepressant continuation or discontinuation, previous course of depressive illness, duration of attempt to conceive, and partner support, 2) to describe the trajectory of depressive symptoms over the course of IVF cycles, and 3) to explore biological markers of the stress response, including those pertaining to HPA axis dysregulation and inflammation associated with depressive relapse and stress during IVF treatment. We will conduct a prospective naturalistic investigation in which participants (N=60) will each be followed longitudinally for six months, during which time they will proceed through at least one IVF cycle. Mood symptoms, antidepressant use, psychotherapy, perceived stress, partner support, use of gonadotropins and any hormonal interventions, and all infertility based treatments and interventions across each cycle will be tracked prospectively. The significance of the proposal is derived from: 1) its public health implications in light of the high prevalence rats of both infertility and major depression in women, 2) the lack of systematic data regarding risk of depressive relapse and predictors of relapse in women undergoing IVF, and 3) the need for systematic study of the biological sequelae of stress among women with histories of depression undergoing treatment for infertility. PUBLIC HEALTH RELEVANCE: This revised proposal is an R21 application for the ORWH Funding Opportunity Announcement "Advancing Novel Science in Women's Health Research (ANSWHR)" (PAS-10-226). We will study risk factors for depressive relapse in women undergoing in vitro fertilization (IVF) with histories of major depression. These data will be used to develop larger studies in which the relationships between major depressive disorder, antidepressant use, and outcomes following infertility treatment are assessed prospectively.

描述（由申请人提供）：此修订提案是ORWH资助机会公告“推进妇女健康研究（ANSWHR）的新科学”（PAS-10-226）的R21申请。重度抑郁症（MDD）在育龄妇女中普遍存在，MDD在不孕症治疗中的过程及其对临床管理的影响尚未得到系统研究。在这个时候，临床医生没有循证治疗指南可以依靠，以建议有MDD病史的妇女计划体外受精（IVF）或其他辅助生殖程序。不孕症治疗的背景是一个有趣的和临床上令人信服的生物应激反应，下丘脑-垂体-肾上腺（HPA）轴失调和抑郁症风险的研究背景。这项研究的目的是：1）描述在接受IVF期间6个月内有抑郁症病史的女性抑郁症复发的临床预测因素，包括：抗抑郁药的持续或停用、既往抑郁症病程、尝试怀孕的持续时间和伴侣支持，2）描述IVF周期过程中抑郁症状的轨迹，3）探索应激反应的生物学标志物，包括与HPA轴失调和炎症相关的生物学标志物，这些生物学标志物与IVF治疗期间抑郁复发和应激相关。我们将进行一项前瞻性的自然调查，其中参与者（N=60）将被纵向随访6个月，在此期间，他们将进行至少一个IVF周期。将前瞻性跟踪每个周期的情绪症状、抗抑郁药使用、心理治疗、感知压力、伴侣支持、促性腺激素和任何激素干预的使用以及所有基于不孕症的治疗和干预。该建议的重要性来自：1）鉴于妇女不孕症和严重抑郁症的高发病率，其对公共卫生的影响，2）缺乏关于不孕症风险的系统数据， 接受IVF的妇女中抑郁复发和复发的预测因素，以及3）需要系统研究有抑郁病史的不孕症治疗妇女中压力的生物学后遗症。 公共卫生相关性：此修订提案是ORWH资助机会公告的R21申请“推进妇女健康研究中的新科学（ANSWHR）”（PAS-10-226）。我们将研究有抑郁症病史的体外受精（IVF）妇女抑郁症复发的危险因素。这些数据将用于 开展更大规模的研究，前瞻性评估重度抑郁症、抗抑郁药使用和不孕症治疗后结局之间的关系。