Course and predictors of depressive relapse during IVF

描述(由申请人提供)：本修订提案是ORWH资助机会公告“推进妇女健康研究中的新颖科学”(PAS-10-226)的R21申请。重度抑郁障碍(MDD)在育龄妇女中普遍存在，MDD在不孕症治疗中的病程及其对临床治疗的影响以前没有得到系统的研究。目前，临床医生还没有循证治疗指南可供参考，以便为计划进行体外受精(IVF)或其他辅助生殖程序的有MDD病史的妇女提供建议。不孕症治疗的背景是一个耐人寻味的和临床上令人信服的环境，研究生物应激反应，下丘脑-垂体-肾上腺(HPA)轴失调，以及严重抑郁症的风险。这项研究的目的是：1)描述在接受体外受精治疗期间有抑郁病史的妇女6个月内抑郁复发的临床预测因素，包括：抗抑郁药物的继续或停止、既往抑郁病程、尝试受孕的持续时间和伴侣支持；2)描述抑郁症状在试管受精周期中的轨迹；以及3)探索应激反应的生物标记物，包括与HPA轴失调和炎症有关的标记物，与体外受精治疗期间抑郁复发和应激有关。我们将进行一项前瞻性的自然主义研究，每个参与者(N=60)将被纵向跟踪六个月，在此期间，他们将至少进行一次试管受精周期。情绪症状、抗抑郁药物的使用、心理治疗、感受到的压力、伴侣支持、促性腺激素和任何激素干预的使用，以及每个周期中所有基于不孕症的治疗和干预都将被前瞻性地跟踪。该提案的意义在于：1)鉴于妇女中不孕不育和严重抑郁症的高患病率，它对公共卫生的影响；2)缺乏关于 在接受体外受精的女性中，抑郁症复发和复发的预测因素，以及3)有抑郁症病史的女性在接受不孕症治疗时，有必要对应激的生物后遗症进行系统研究。

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.