Women's decisionmaking around the use of antidepressant medications during pregnancy

Between 8-20 percent of pregnant women experience clinical depression. The majority is sub-optimally treated or untreated. Women who discontinue taking antidepressants at conception are at tremendous risk of relapse (68%), and inadequate treatment of depression during pregnancy contributes to maternal suicide, reduced use of prenatal care, substance abuse, self neglect, and premature infants. The National Institute of Mental Health has identified health services research around maternal depression as a priority area for research. Anecdotal evidence suggests that many pregnant women discontinuing antidepressant therapy out of fears about risks to the fetus that are, in fact, unfounded, and the misperception that pregnancy is a time of emotional wellbeing, conferring “protection” against psychiatric disorders. A major obstacle to providing optimal treatment and counseling of depressed, pregnant women is that data are lacking on the reasons why women discontinue their antidepressants. We conducted a pilot qualitative interview study with a convenience sample of 25 women who were taking antidepressants prior to planning or initiating a pregnancy. The vast majority of women chose to discontinue medication, and a majority of these women experience some level of relapse but felt they had to suffer in order to protect their fetus. Beliefs about the risks of antidepressants appear to be grounded in cultural expectations that women will keep their bodies “clean” during pregnancy. Further research needs to explore whether and how women can absorb new messages that a woman's mental health is just as important to her growing fetus as her physical health.