From the constant barrage of \u201care you pregnant yet?\u201d to the disappointment of yet another negative pregnancy test, it\u2019s no surprise that many women with fertility issues must also deal with deep feelings of sadness and frustration. In fact, negative feelings are common in those struggling to become or stay pregnant. Sometimes, though, those emotions turn into more than a case of the blues; sometimes they turn into a very serious clinical depression. Clinical depression is more than feeling sad or blue. Rather, it includes living with feelings of sadness, hopelessness and helplessness that last at least two weeks (and often much longer) that significantly interfere with one\u2019s life. Depression negatively impacts your emotional well-being, so you might cry frequently, become easily irritated with others, struggle with a lack of motivation and live with anxiety and worry.\u00a0 Sleep, appetite and energy levels are often disrupted.\u00a0 In serious cases, depression often leads to serious thoughts of suicide and suicide attempts. The Emotional Strain of Infertility It is normal to feel sad when dealing with fertility challenges. These emotions can be caused by any number of things, like a negative pregnancy test or an invitation to a friend\u2019s baby shower. You may experience sadness, frustration, or disappointment when your period arrives or after a miscarriage. A woman dealing with infertility can also feel pressure from family and friends.\u00a0 You might be bombarded with questions from relatives who don\u2019t understand what\u2019s \u201cwrong\u201d or who say insensitive things. You can also be peppered by people wondering when you\u2019re going to start a family. Holidays and family gatherings, like birthday parties, can be especially hard when children are the focus. Media outlets don\u2019t make the situation any easier. Celebrity baby watches are common, with frequent reports on everything from how much weight this A-lister gained to what kinds of baby swag that celeb is stocking up on. If you\u2019re struggling with infertility, this makes it seem as though everyone is getting pregnant. The cost of fertility treatments adds to the stress and strain that contribute to depression. Few states mandate insurance coverage for these procedures, leaving women or couples left to foot the bill. Some dealing with infertility are faced with tough financial decisions, such as whether to borrow money to fund treatment. Others may find that they just cannot afford fertility help. Additionally, depression may become worse if infertility continues for a long time. One study found significantly higher depression scores in women who had experienced fertility problems for 2-3 years and lower levels in those who had been coping with the issue for a year or less. Why Depression Treatment Is Critical Depression symptoms have a serious impact on your well-being. You may live with fatigue that makes it impossible for you to face other responsibilities; you may be weighed down by feelings of guilt or worthlessness; or you might feel numb and empty. Symptoms can be physical as well, disrupting the quality of sleep, causing aches and pains that seem to have no specific cause and triggering overeating or weight loss. Consider also that depression symptoms may contribute to continued infertility. For example, depression-induced overeating, and the weight gain that comes with it, can decrease fertility. Women who self-medicate depression with alcohol or smoking can be less fertile as well. Treating Depression Caused by Infertility If you are still going through fertility treatments, it\u2019s critical to work with both your fertility specialist and your mental health professional to determine if antidepressants are appropriate. Researchers now believe that selective serotonin reuptake inhibitors (SSRIs) decrease pregnancy rates in women undergoing fertility treatments. In addition, evidence suggests that the drugs raise the risk of miscarriage, pre-term birth, and other neo-natal complications, including heart defects. In serious cases of depression, especially those that include suicidal thoughts or actions, it may be necessary to put fertility treatments on hold while using antidepressants to help brain chemistry get back into balance. However, medication is not the only option for treating depression. In fact, cognitive behavioral therapy (CBT) has been shown to be more effective than medication in treating infertile women. In the study, one group of women attended 10 CBT sessions to restructure their thinking patterns and receive relaxation training; 79% reported significant reduction of depression symptoms. In contrast, just 50% of a group treated only with the antidepressant fluoxetine reported fewer depression symptoms. Therapy is also essential for treating depression symptoms in cases where it becomes clear that a pregnancy may never happen. It\u2019s a reality that some women dealing with infertility may eventually need to face. A therapist will help you work through the emotions so you can cope with a different kind of future in a healthy way. Stress Relief for Infertility and Depression Chronic stress can contribute to both issues. For example, while physicians (and grandmothers) have long advised women to relax in order to get pregnant, research now suggests there is truth behind the advice. A study funded by the National Institutes of Health (NIH) and the University of Oxford found that women with higher levels of stress-related substances in their blood were less likely to become pregnant than those with lower levels. Chronic stress also reduces levels of serotonin, creating imbalanced brain chemistry and leading to depression symptoms. \tSet limits for child-focused activities. It\u2019s OK if you aren\u2019t ready to face the stress, anxiety, or sadness that can be triggered by a nephew\u2019s birthday party or handing out Halloween candy. If necessary, acknowledge the event by sending a card. Prevent any pain you might feel shopping for a child\u2019s present by sending a gift card instead. \tFind an activity you love. Don\u2019t let fertility issues consume you. Relieve stress by taking up an activity you genuinely enjoy, whether it\u2019s dancing the salsa or rediscovering your love for guitar playing. Not sure what to do? Dive into something new by taking a class in an activity that has always intrigued you, like pottery or baking. \tLearn relaxation techniques. From deep breathing exercises to biofeedback, your therapist will help you find practical ways to relieve the negative emotions that cause depression and contribute to infertility. Coping with fertility issues can be painful, but you can work through your emotions in a healthy way. Consult a mental health professional for an evaluation and to determine the best course of treatment.\u00a0 Depression doesn\u2019t have to last forever \u2013 with appropriate treatment you can begin to feel happy and enjoy life once again.