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（ANSWHR）的新科学”（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管理的影响尚未得到系统的研究。目前，临床医生没有基于证据的治疗指南来建议有重度抑郁症病史的妇女进行体外受精（IVF）或其他辅助生殖手术。不孕症治疗的背景是研究生物应激反应、下丘脑-垂体-肾上腺（HPA）轴失调和重度抑郁症风险的一个有趣和临床引人注目的环境。本研究的目的是：1)描述有抑郁症病史的妇女在接受试管婴儿治疗的6个月内抑郁症复发的临床预测因素，包括：抗抑郁药物的持续或停止，既往的抑郁症病程，尝试怀孕的持续时间，以及伴侣的支持，2)描述IVF周期过程中抑郁症状的轨迹，3)探索压力反应的生物学标记，包括与HPA轴失调和炎症相关的生物标记，这些标记与IVF治疗期间抑郁复发和压力有关。我们将进行一项前瞻性自然调查，其中参与者（N=60）将被纵向随访六个月，在此期间他们将进行至少一个试管婴儿周期。情绪症状、抗抑郁药的使用、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，以及每个周期内所有基于不孕症的治疗和干预都将进行前瞻性跟踪。该建议的重要性源于：1)鉴于女性不孕和重度抑郁症的高患病率，其公共卫生影响；2)缺乏有关风险的系统数据

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.