Eakley Rachel, Lyndon Audrey
Rory Meyers College of Nursing, New York University, New York, New York.
J Midwifery Womens Health. 2022 May;67(3):332-353. doi: 10.1111/jmwh.13366. Epub 2022 May 10.
Despite the risks associated with untreated perinatal depression and anxiety, both patients and clinicians are less likely to follow evidence-based guidelines including the use of antidepressants during pregnancy. The aim of this integrative review was to describe the perspectives of both patients and prescribing health care providers regarding the use of antidepressants during pregnancy.
We performed a literature search in PubMed, CINAHL, ProQuest Central, and PsychINFO. Inclusion criteria were English language, original peer-reviewed research published within the previous 10 years that described perspectives regarding the use of antidepressants of pregnant patients or prescribing providers during pregnancy. Studies were excluded if their focus was on screening practices, treatment guidelines, or evaluation of decision support tool; medication or treatment broadly; bipolar disorder or serious mental illness; or they did not provide patient or provider perspective. This review was limited to professionals with scopes of practice that include prescriptive authority (eg, physicians, advanced practices nurses, midwives). Included articles were critically appraised and read in an iterative process to extract methodological details and synthesize findings.
Nineteen studies met criteria for inclusion and varied by design, sample, and quality. Together, the reviewed articles suggest that patients and prescribing providers hold a range of beliefs regarding the safety of antidepressant during pregnancy. Patients and providers appear to value different sources of information and varied in awareness of the negative impacts of untreated depression and anxiety during pregnancy. Many patients report dissatisfaction with available information and distress throughout the decision-making experience. Notably, patients and providers had incongruent perceptions of the others' experience.
Inconsistencies between knowledge, attitudes, and decision-making highlight the need for improved dissemination of evidence-based treatments and support increased training for psychopharmacology during pregnancy. Efforts to reduce patient distress regarding their decisions, such as adequate time and information, are indicated.
尽管未治疗的围产期抑郁和焦虑存在风险，但患者和临床医生都不太可能遵循循证指南，包括在孕期使用抗抑郁药。本整合性综述的目的是描述患者和开处方的医疗保健提供者对于孕期使用抗抑郁药的看法。
我们在PubMed、CINAHL、ProQuest Central和PsychINFO中进行了文献检索。纳入标准为英文、过去10年内发表的经同行评审的原创研究，该研究描述了孕妇或孕期开处方提供者对于使用抗抑郁药的看法。如果研究重点是筛查实践、治疗指南或决策支持工具的评估；广泛的药物或治疗；双相情感障碍或严重精神疾病；或者未提供患者或提供者的观点，则将其排除。本综述仅限于具有处方权的专业人员（如医生、高级执业护士、助产士）。对纳入的文章进行严格评估，并通过反复阅读来提取方法学细节并综合研究结果。
19项研究符合纳入标准，在设计、样本和质量方面各有不同。综合来看，这些综述文章表明，患者和开处方的提供者对于孕期抗抑郁药的安全性持有一系列看法。患者和提供者似乎重视不同的信息来源，并且在对孕期未治疗的抑郁和焦虑的负面影响的认知上存在差异。许多患者报告对现有信息不满意，并在整个决策过程中感到困扰。值得注意的是，患者和提供者对彼此的经历有不一致的看法。
知识、态度和决策之间的不一致凸显了改善循证治疗传播的必要性，并支持增加孕期精神药理学方面的培训。建议采取措施减少患者对其决策的困扰，比如提供足够的时间和信息。
