Perinatal Antidepressant Use

Abstract

Perinatal depression is prevalent and linked with a host of adverse consequences for women and newborns. Rates of engagement in depression treatment are, however, strikingly low among pregnant and postpartum women, with the majority of affected women receiving no mental health treatment. Research indicates that perinatal women are extremely reluctant to take antidepressant medications, yet the nature of women’s concerns and treatment decisionmaking patterns have not been well documented. Developing a clearer understanding of women’s treatment preferences and behaviors may help identify solutions to the under-treatment of perinatal depression. In this mixed methods study, we conducted in-depth interviews with 61 pregnant women, approximately half of whom were experiencing clinical levels of depression. In addition to assessing psychiatric diagnoses, symptoms, and functional impairment, we conducted qualitative interviews addressing women’s preferences for depression treatment, concerns, and decision-making patterns. Consistent with prior reports, women were significantly more likely to voice a preference for non-pharmacologic depression treatments, as opposed to antidepressant medications. Many depressed women reported a great degree of uncertainty regarding how to treat their depression, and those with more severe depression symptoms were more likely to endorse decisional conflict. Analysis of qualitative comments yielded detailed information about the nature of women’s concerns and preferences related to use of antidepressant medications and other aspects of treatment engagement. We discuss findings in the context of improving patient-centered care for perinatal depression.

A pragmatic randomized clinical trial of behavioral activation for depressed pregnant women.

“…These data suggest that suggest pregnant women and their offspring may be exposed to the adverse effects of depression during pregnancy if interventions are not provided that are well aligned with women’s preferences. Although pregnant women express preference for psychotherapy (Battle et al, 2013; O’Mahen & Flynn, 2008), the paucity of scalable psychotherapies limits access for many pregnant women. To close the gap between treatment need and receipt among depressed pregnant women, it is imperative to provide access to effective, nonpharmacological intervention.…”

“…In fact, the rise in antidepressant use among pregnant women has been described as “dramatic,” from under 1% of pregnant women prior to 1988 to more than 7% in 2008 (Mitchell et al, 2011). This is noteworthy in light of women’s documented preferences for nonpharmacological depression care (Battle, Salisbury, Schofield, & Ortiz-Hernandez, 2013) and high rates of relapse among pregnant women who discontinue antidepressant use (L. S. Cohen et al, 2006; Roca et al, 2013).…”

Potential for Prenatal Yoga to Serve as an Intervention to Treat Depression During Pregnancy

“…Pregnant women have unique concerns that influence their treatment decisions, and the most available depression treatment in the community, antidepressant medication, is viewed by many women to be unacceptable during pregnancy (Battle, Salisbury, Schofield, & Ortiz-Hernandez, 2013). Fetal exposure concerns are common among both women and providers, and risk / benefit decision-making can be complex due to the large and at times conflicting literature addressing the safety of prenatal antidepressant use (Chaudron, 2013).…”

Perinatal Dyadic Psychotherapy for postpartum depression: a randomized controlled pilot trial

“…Antidepressants can effectively decrease PPD symptoms (e.g., Cohen et al 2001; Wisner et al 2002; Yonkers et al 2008); nevertheless there is great reluctance among many postpartum women to take medication, even if not breastfeeding (Goodman 2009). Most women instead prefer psychotherapy (Battle et al 2013; Cooper and al. 2003; Goodman 2009), but the logistics of getting to therapy appointments can be overwhelming for a depressed mother of a newborn.…”