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: 2.16). 12/2005; 8(4):214-20. DOI: 10.1007/s00737-005-0094-8
Source: PubMed


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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    • "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 · 2.16 Impact Factor
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    • "Similarly, a study by Sanz et al. [56], concluded that overestimated risk perception among women and health professionals led to induced abortions of healthy and wanted babies. Women’s perceptions of risk of the use of antidepressants during pregnancy has also been explored with 87% of women mistakenly believing that antidepressant use during pregnancy increased the risk of congenital abnormalities [57]. "
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    ABSTRACT: The perceived risk/benefit balance of prescribed and over-the-counter (OTC) medicine, as well as complementary therapies, will significantly impact on an individual's decision-making to use medicine. For women who are pregnant or breastfeeding, this weighing of risks and benefits becomes immensely more complex because they are considering the effect on two bodies rather than one. Indeed the balance may lie in opposite directions for the mother and baby/fetus. The aim of this paper is to generate a discussion that focuses on the complexity around risk, responsibility and decision-making of medicine use by pregnant and breastfeeding women. We will also consider the competing discourses that pregnant and breastfeeding women encounter when making decisions about medicine. Women rely not only on biomedical information and the expert knowledge of their health care professionals but on their own experiences and cultural understandings as well. When making decisions about medicines, pregnant and breastfeeding women are influenced by their families, partners and their cultural societal norms and expectations. Pregnant and breastfeeding women are influenced by a number of competing discourses. "Good" mothers should manage and avoid any risks, thereby protecting their babies from harm and put their children's needs before their own - they should not allow toxins to enter the body. On the other hand, "responsible" women take and act on medical advice - they should take the medicine as directed by their health professional. This is the inherent conflict in medicine use for maternal bodies. The increased complexity involved when one body's actions impact the body of another - as in the pregnant and lactating body - has received little acknowledgment. We consider possibilities for future research and methodologies. We argue that considering the complexity of issues for maternal bodies can improve our understanding of risk and public health education.
    BMC Public Health 11/2011; 11 Suppl 5(Suppl 5):S5. DOI:10.1186/1471-2458-11-S5-S5 · 2.26 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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    ABSTRACT: In order to examine the risk perception of using Over the Counter (OTC) cold/flu remedies, data were collected on a series of cognitive, attitudinal and intentionto- behave variables in the context of the Theory of Planned Behavior (TPB). This proposal by Fishbein and Ajzen allows for the analysis of relationships between behavior and several psychosocial antecedents. A total of 900 women aged 20 to 60 years, randomly selected from all 16 boroughs of Mexico City participated in this ex post facto study. They were of low socioeconomic status and mothers of at least one child. Measurement included validated questionnaires on the components of the TPB: beliefs, attitudes, subjective norms, motivation to please, intentions and behavior. Statistical tools included linear analysis through stepwise multiple regression including the establishment of the relative weight of each component of the theory in predicting the use of medications. Risk perception alone was a relatively poor predictor of medication use, intention and behavior. Subjective norm and motivation to please jointly achieved a better predictive level, in contrast to attitudes and beliefs, which resulted in low predictive values.
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