Making decisions about antidepressant use during pregnancy: a qualitative interview study of a sample of women in the UK

Abstract

Background An increasing number of pregnant women now take antidepressants. Many pregnant women experience decisional conflict when deciding whether to take antidepressants, but little is known about the attitudes and experiences that influence these decisions. Aim To explore the attitudes and experiences influencing women’s decisions about antenatal antidepressant use. Design and setting A qualitative study using in-depth interviews with a sample of UK women who experienced antenatal depression or took antidepressants antenatally within the preceding 3 years. Method Recruitment adverts were placed by a perinatal mental health charity and on parenting forums and social media platforms, resulting in a convenience sample. Interview data were coded and analysed with thematic analysis using QSR NVivo. Results Twenty-two women were interviewed; one-half had taken antidepressants during pregnancy. Most women had concerns about adverse effects and viewed antidepressants as adjunctive to non-pharmacological treatments, which were reported as difficult to access. Some women reported that professional advice was insufficiently detailed. Women described the need to cope with their symptoms, their baby, and existing responsibilities, and related their decisions to their perceived ability to cope. This perception was influenced by physical and emotional challenges relating to pregnancy. Women’s decisions were influenced by their previous experiences and by the perceived societal expectations placed on pregnant women. Conclusion Decision making is a complex and dynamic process, personal to each woman’s circumstances. Perceived ability to cope is an important factor in decision making. Detailed information should be offered to women for support with decision making in relation to antenatal medication use.