Bonari L, Bennett H, Einarson A, Koren G. Risks of untreated depression during pregnancy. Can Fam Physician. 2004; 50:37-9

Bonari L, Koren G, Einarson TR, Jasper JD, Taddio A, Einarson A. Use of antidepressants by pregnant women: evaluation of perception of risk, efficacy of evidence based counseling and determinants of decision making. Arch Women Ment Health. 2005; 8:(4)214-20

Bowling A, Ebrahaim S. Handbook of Health Research Methods.Maidenhead: Open University Press; 2005

British Psychological Society, Royal College of Psychiatrists. Antenatal and Postnatal mental health: Clinical management and service guidance; updated edition. 2015. (accessed 6 April 2018)

Bruera E, Willey JS, Lynn Palmer J, Rosales M. Treatment decisions for breast carcinoma. Cancer. 2002; 94:(7)2076-80

Critical Appraisal Skills Programme. CASP Checklists. 2016. (accessed 6 April 2018)

Chan J, Natekar A, Einarson A, Koren G. Risks of untreated depression in pregnancy. Can Fam Physician. 2014; 60:(3)242-3

Crombie IK. The Pocket Guide to Critical Appraisal.London: BMJ Publishing Group; 1996

Deber RB, Kraetschmer N, Irvine J. What role do patients wish to play in treatment decision making?. Arch Intern Med. 1996; 156:(13)1414-20

Degner LF, Sloan JA, Venkatesh P. The control preferences scale. Can J Nurs Res. 1997; 29:(3)21-43

de Jonge A. Support for teenage mothers: a qualitative study into the views of women about the support they received as teenage mothers. J Adv Nurs. 2001; 36:(1)49-57

Einarson A. Antidepressant use during pregnancy: navigating the sea of information. Can Fam Physician. 2013; 59:(9)943-4

Einarson A, Egberts TC, Heerdink ER. Antidepressant use in pregnancy: knowledge transfer and translation of research findings. J Eval Clin Pract. 2015; 21:(4)579-83

Engelstad HJ, Roghair RD, Calarge CA, Colaizy TT, Stuart S, Haskell SE. Perinatal outcomes of pregnancies complicated by maternal depression with or without selective serotonin reuptake inhibitor therapy. Neonatology. 2014; 105:(2)149-54

Gavin NI, Gaynes BN, Lohr KN, Meltzer-Brody S, Gartlehner G, Swinson T. Perinatal depression. Obstet Gynecol. 2005; 106:(5, Part 1)1071-83

db Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2006; 18:(1)59-82

Hack TF, Degner LF, Watson P, Sinha L. Do patients benefit from participating in medical decision making? Longitudinal follow-up of women with breast cancer. Psycho-oncology. 2006; 15:(1)9-19

Hayes LJ, Goodman SH, Carlson E. Maternal antenatal depression and infant disorganized attachment at 12 months. Attach Hum Dev. 2013; 15:(2)133-53 80/14616734.2013.743256

Heron J, O'Connor TG, Evans J, Golding J, Glover V The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord. 2004; 80:(1)65-73

Prevention in Mind: All Babies Count: Spotlight on Perinatal Mental Health. 2013. (accessed 6 April 2018)

Kunneman M, Pieterse AH, Stiggelbout AM Treatment preferences and involvement in treatment decision making of patients with endometrial cancer and clinicians. Br J Cancer. 2014; 111:(4)674-9

Knight M, Nair M, Tuffnell D Saving Lives, Improving Mothers' Care: Surveillance of maternal deaths in the UK 2012–14 and lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2009-14.Oxford: National Perinatal Epidemiology Unit, University of Oxford; 2016

Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014. 2016. (accessed 6 April 2018)

National Institute for Health and Care Excellence. Managing mental health problems in pregnancy and the postnatal period. 2014. (accessed 6 April 2018)

O'Connor AM. Validation of a decisional conflict scale. Med Decis Making. 1995; 15:(1)25-30

Patel SR, Wisner KL. Decision making for depression treatment during pregnancy and the postpartum period. Depress Anxiety. 2011; 28:(7)589-95

PRISMA. PRISMA 2009 Flow Diagram. 2009. (accessed 6 April 2018)

Sedgwick P. Sample size and power. BMJ. 2011; 343

Guiding/coaching in deliberation and communication. 2012. (accessed 6 April 2018)

Stepanuk KM, Fisher KM, Wittmann-Price R, Posmontier B, Bhattacharya A. Women's decision-making regarding medication use in pregnancy for anxiety and/or depression. J Adv Nurs. 2013; 69:(11)2470-80

UK Teratology Information Service. Use of Selective Serotonin Reuptake Inhibitors in pregnancy. 2016. (accessed 6 April 2018)

Vesga-López O, Blanco C, Keyes K, Olfson M, Grant BF, Hasin DS. Psychiatric disorders in pregnant and postpartum women in the United States. Arch Gen Psychiatry. 2008; 65:(7)805-15

Walton GD, Ross LE, Stewart DE, Grigoriadis S, Dennis CL, Vigod S. Decisional conflict among women considering antidepressant medication use in pregnancy. Arch Women Ment Health. 2014; 17:(6)493-501

Wittmann-Price RA. Emancipation in decision-making in womens health care. J Adv Nurs. 2004; 47:(4)437-45

Are women empowered to make decisions about the use of antidepressants in pregnancy?

02 May 2018
Volume 26 · Issue 5



Untreated depression is related to maternal mortality and morbidity. The most frequent treatment is antidepressant medication, but studies have shown that women find decisions about the use of antidepressants in pregnancy difficult and confusing.


To explain if women are empowered to make decisions around the use of antidepressants in pregnancy.


A literature review was conducted using CINAHL Complete, Intermid, Proquest and Discover More.


Information provision was inadequate and women experienced decisional conflict. Women wanted to be involved in a collaborative decision-making process.


Women want to be provided with clear and accurate information and prefer to collaborate when making decisions about antidepressants in pregnancy. More research is needed to explore demographic gaps within population samples, and women's experiences of decision-making about antidepressant usage. Undergraduate and postgraduate health education should include conversation skills training, associated with collaborative discussion and informed choice.

Depression and anxiety are two of the most common health problems in pregnancy in the UK, affecting 12% and 13% of women, respectively (Heron et al, 2004; Gavin et al, 2005; Vesga-Lopez et al, 2008). The most common treatment is antidepressant medication (McManus et al, 2016). According to Einarson (2013), in 2013, antidepressants were the most researched drugs during pregnancy, and the findings related to risk of adverse effects for the fetus generated more than 30 000 potential outcomes. Outcomes included, spontaneous abortion, low birth weight, preterm birth, congenital malformations, neonatal withdrawal syndrome and persistent pulmonary hypertension of the newborn, in addition to the maternal morbidity incurred as a consequence of poor outcome (Bonari et al, 2004; Chan et al, 2014; UK Teratology Information Service (UKTIS), 2016). However, risks are difficult to quantify due to conflicting findings from teratological research (UKTIS, 2016) and the observational methods used, since pregnant women are not included in randomised controlled trials for antidepressant drugs (Einarson et al, 2015). Ambiguity around risk factors makes decision-making about antidepressant usage during pregnancy a complex process (Bonari et al, 2005; Patel et al, 2011; Stepanuk et al, 2013; Walton et al, 2014). This literature review therefore seeks to explore whether women feel empowered to make complex decisions about antidepressants in pregnancy.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month