Use of antidepressants by pregnant women: Evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making

The Motherisk Program, The Hospital for Sick Children, Toronto, Canada.
Archives of Women s Mental Health (Impact Factor: 1.96). 12/2005; 8(4):214-20. DOI: 10.1007/s00737-005-0094-8
Source: PubMed

ABSTRACT The World Health Organization predicts that by 2012, depression will be the number one disease in the world. Thus, many women who become pregnant will require treatment with antidepressants. We are aware that women and their health care providers remain hesitant to prescribe and take these drugs during pregnancy, despite evidence of the relative safety.
1) To determine perception of risk of antidepressant drugs by pregnant women with depression, 2) to determine the efficacy of evidence-based counseling, and 3) to identify determinants that influence women in their decision making regarding the continuation/discontinuation of antidepressants during pregnancy.
Women who called The Motherisk Program requesting information about the safety of an antidepressant during pregnancy were compared with two other groups: 1) Women who called about antibiotic use (i.e., non-teratogenic drugs used short-term) and 2) women who called about gastric medications (i.e., non-teratogenic drugs used long-term). Their perception of risk was measured before and after evidenced-based information was given and determinants of decision making was also evaluated.
We recruited 100 women taking antidepressants during pregnancy and 100 in each comparison group. Despite receiving evidence-based reassuring information, 15% of antidepressant users, compared to 4% using gastric drugs and 1% using antibiotics, chose to discontinue their medication. The main determinants of decision making were based on: information received prior to calling Motherisk, family and friends advice, the internet, sequence of advice given and if a women was undecided at the time of call.
Women continue to fear taking antidepressants during pregnancy, more so than non psychiatric drugs, however, evidence based counseling can lower this fear, although not totally. Deciding whether to continue to take a medication or not during pregnancy, is a complex decision for women and their healthcare providers to make.

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Available from: John D Jasper, Dec 31, 2013
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    • "In this study, family and friends' advice and the internet were important influences (Bonari et al. 2005). These factors are consistent with the findings of the current study and strongly support our findings that decision-making in this area is more complex than weighing specific risks and benefits of potential treatment options. "
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    ABSTRACT: The purpose of this study was to examine decision-making among women considering antidepressant medication use in pregnancy. Decisional conflict was assessed using the Decisional Conflict Scale (DCS) among pregnant women considering antidepressant medication treatment (N = 40). Overall DCS and subscale scores were compared between women who were antidepressant users and non-users. Semi-structured interviews (N = 10) explored barriers and facilitators of decision-making. Twenty-one women (52 %) had moderate or high decisional conflict (DCS ≥ 25). Overall DCS scores did not differ between groups, but antidepressant use was associated with feeling more adequately informed (subscale mean 17.5, SD 17.9 vs. 42.1, SD 23.8, p = 0.001) and clear about values (subscale mean 16.7, SD 15.1 vs. 29.8, SD 24.0, p = 0.043). Barriers to decision-making were (1) difficulty weighing maternal versus infant health, (2) lack of high quality information, (3) negative external influences, and (4) emotional reactions to decision-making. Facilitators were (1) interpersonal supports, (2) accessible subspecialty care, and (3) severe depressive symptoms. Many pregnant women facing decisions regarding antidepressant medication use experience decisional conflict. Interventions that provide accurate information, assistance with weighing risks and benefits of treatment, management of problematic external influences, and emotional support may reduce decisional conflict and facilitate the decision-making process.
    Archives of Women s Mental Health 08/2014; 17(6). DOI:10.1007/s00737-014-0448-1 · 1.96 Impact Factor
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    • "In the general area interfacing risk perception, health and psychology, a wide variety of research topics have received recent attention. Among many other, some such lines include: the effects of counseling on risk perception related to decision-making on hormone replacement therapy in healthy women with a family history of breast cancer (Matloff, Moyer, Shannon, Niendorf, and Col, 2006); risk perceptions and care seeking practices for malaria among pregnant adolescents (Mbonye, Neema, and Magnussen, 2006); patients' perceptions of cholesterol and cardiovascular disease risk (Goldman et al., 2006); dimensions of choice in accepting smallpox vaccination (Kaltman, Tractenberg, Taylor, and Green, 2006); treating and drinking well water in the presence of health risks from arsenic contamination (Shaw, Walker, and Benson, 2005); antidepressants use by pregnant women (Bonari et al., 2005), and health beliefs and regimen adherence in minority adolescents with Type 1 diabetes (Patiño, Sánchez, Edison, and Delamater, 2005). Another topic of risk perception in the health area involves the use of prescribed medications. "
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    • "A growing body of literature supports the use of a systematic and 'evidence based' approach to health care (Freemantle et al., 2000; Eccles et al., 2001), but little is known about the patient decision process in treatment of TN. Decision analysis in the health care context combines evidence and helps to determine the optimal strategy under given circumstances (Bonari et al., 2005; Lipton et al., 2005). When used to analyse decisions, this method helps establish the 'best' treatment, from the patient perspective (Fyffe and Kay, 1992; Petitti, 2000). "
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    ABSTRACT: Trigeminal neuralgia (TN) is a rare form of neuropathic facial pain characterised by severe, paroxysmal pains in the face. Little is known about the decision process in treatment of TN, and management with anti-epileptic drugs or surgical procedures carries risks of side effects, recurrence and complications. One hundred fifty-six previously diagnosed TN patients completed an adapted time-trade-off utility measurement questionnaire to ascertain how they valued the potential outcomes from various surgical and medical treatments. The decision analysis revealed that microvascular decompression surgery (MVD) offered the best chance of improved quality of life or highest maximum expected utility (MEU). MVD (MEU=16.08 out of a possible 20) was closely followed by balloon compression (MEU=15.97), percutaneous glycerol rhizolysis (MEU=15.61) and then radiofrequency thermocoagulation (MEU=14.93). Medication offered the least optimal chance of improved quality of life (MEU=14.61). The difference between the highest (MVD) and lowest scoring treatments (medication) was 7.3% (1.46/20). These results were sensitive to some utility values, meaning the preferred treatment is changed by the values patients assign to outcomes. As surgical techniques narrowly offer the highest chance of maximising patient quality of life, all patients with TN should consider surgery. However, surgery is not right for everyone, and patients should be informed about their full range of choices. Treatment decisions must take place after careful consideration of the values patients place on benefits and risks of treatment.
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