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A very capable professional woman in her mid-30s became depressed as a consequence of difficulties in conceiving a child. The couple had delayed trying to have children, and desperately desired to become parents. The difficulty in conceiving, and consequent involvement in an IVF program, also led to significant marital stress.

The patient had started to cry frequently and had some suicidal thoughts (although she had no intent to act upon them). She had little energy and was easily fatigued -- in contrast to her usual active and productive self. She developed insomnia, her concentration was impaired, and she lost her appetite. At times she would shop and spend more than usual in order to cheer herself up.

She was referred to a counsellor for both individual and marital therapy. The individual counselling focused upon the issues of her grief over not being able to bear children, her guilt about not attempting to conceive earlier, and the tension within the marriage. However, despite skilled therapy for an adequate time, her symptoms persisted.

At that point she was referred for a trial of antidepressants. To the surprise of her medical practitioner, she responded rapidly to a selective serotonin reuptake inhibitor. A few months later, when she decided to stop taking the drug, the symptoms returned, again remitting on reintroduction of the antidepressant. Her symptomatic improvement then allowed her to engage more productively in psychotherapy, but she has also elected to continue antidepressant drug therapy.

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