Predictive Factors of Antidepressant Response and Remission to Bupropion Extended-Release or Psychosexual Therapy Among Infertile Women With Sexual Dysfunction

Infertility is described as a major crisis in life, which can significantly affect the psychological well-being of infertile women (1-3). Inability to conceive a child is associated with common mental consequences such as low self-efficacy, emotional burden, depression, and sexual problems (4-7). Studies show that infertile women are more likely to experience depression, and depression is considered as a prevalent sequel of infertility (2), which has an inverse effect on success of fertility (8,9). Pharmacological and non-pharmacological treatment options are used to improve depression (6). A review of the literature showed that psychological method was an effective therapy for depression (10), and was valuable for remission of depression (11,12). Furthermore, bupropion (BUP) is an effective antidepressant drug (13). It acts as a supplemental treatment to reverse antidepressantincluded sexual dysfunction (SD), and increase sexual activity (13,14). Studies showed that success rate in treating depression can be up to 50%-60% in psychotherapy or pharmacotherapy (15,16), but numerous factors including socio-demographic characteristics of age, social support, economic status, being married, and family intervention could affect antidepressant response or remission (17,18). Moreover, the role of clinical predictors of baseline depression levels, and duration of episodes in outcomes are important; all of which are inadequately understood (19,21). In a review of predictors of depression, AkhtarDanesh and Landeen reported that age-predicted depression can affect resilient outcome (22). Another study revealed non-biological predictors of antidepressant response such as severe depression, long duration of episodes, duration of treatment, treatment dosage, severe inactivity, and overeating (23). Flynn et al reported that severity of depression can be considered as a significant predictor of depression treatment (24). Few studies have determined baseline depression levels as a moderator of depression outcomes between available treatment methods in infertility, to such an extent that some physicians rely on baseline symptoms to choose between initial drug therapy and other treatment methods. They suggest that checking medication and symptoms is a useful strategy Abstract Objectives: This study aimed to evaluate the predictive factors of antidepressant response and remission to bupropion extendedrelease (BUP ER) or psychosexual therapy (PST) among infertile women with sexual dysfunction (SD). Materials and Methods: As a randomized controlled clinical trial, this prospective study was carried out on 3 groups of BUP ER (n = 31), PST (n = 31), and control (n = 31) in infertile women with SD in Babol, Iran during 2014-2015. Logistic regression was used to detect predictors of antidepressant response and remission. Results: Antidepressant response and remission rates were 58.1% and 54.8 % respectively in the PST group. Of the infertile women in the BUP group, 41.9% reached response and remission by the end of the study. The results for PST contained 2 predictors: occupation in response and remission (odds ratio [OR] = 0.171, P = 0.036; OR = 0.1, P = 0.013; respectively), and frequency of sexual intercourse in response (OR = 0.124; P = 0.040). The results for BUP contained three predictors: baseline severe depression level in remission (OR = 0.044, P = 0.010), economic status in response and remission (OR = 5.850, P = 0.027), and age difference of spouses in response (P = 0.031). Conclusions: Depression screening and physician notification of demographic, reproductive and clinical predictors of antidepressant response and remission are necessary for selecting effective treatment interventions.