Bonari L, Koren G, Einarson T R, Jasper J D, Taddio A, Einarson A
The Motherisk Program, The Hospital for Sick Children, Toronto, Canada.
Arch Womens Ment Health. 2005 Nov;8(4):214-20. doi: 10.1007/s00737-005-0094-8. Epub 2005 Jun 17.
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.
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.
世界卫生组织预测，到2012年抑郁症将成为全球第一大疾病。因此，许多怀孕女性将需要使用抗抑郁药进行治疗。我们注意到，尽管有证据表明这些药物相对安全，但女性及其医疗服务提供者在孕期开处方和服用这些药物时仍犹豫不决。
1）确定患有抑郁症的孕妇对抗抑郁药风险的认知；2）确定循证咨询的效果；3）确定影响女性在孕期决定是否继续使用抗抑郁药的因素。
将致电母婴风险计划询问孕期抗抑郁药安全性信息的女性与另外两组进行比较：1）致电询问抗生素使用情况的女性（即短期使用的非致畸药物）；2）致电询问胃药使用情况的女性（即长期使用的非致畸药物）。在提供循证信息前后测量她们的风险认知，并评估决策的影响因素。
我们招募了100名孕期服用抗抑郁药的女性以及每组100名的对照组女性。尽管收到了循证的安心信息，但与4%使用胃药和1%使用抗生素的女性相比，仍有15%服用抗抑郁药的女性选择停药。决策的主要影响因素基于：致电母婴风险计划之前获得的信息、家人和朋友的建议、互联网、所给建议的顺序以及女性在致电时是否犹豫不决。
与非精神科药物相比，女性在孕期仍更害怕服用抗抑郁药，然而，循证咨询可以降低这种恐惧，尽管不能完全消除。对于女性及其医疗服务提供者来说，决定孕期是否继续用药是一个复杂的决策。
