Perinatal depression: Therapeutic shared decision-making in primary care

Abstract

The increasing use of antidepressants, escalating rates of unintended pregnancy, and disproportionately high rate of maternal suicide in the United States, as compared with other high-income countries, all highlight the urgent need for more clarity on available treatment options for perinatal depression. Misrepresentative data obtained from animal experiments and observational human studies, many of which do not account for underlying mental illness as a confounder, largely overestimate the teratogenicity of antidepressants. These outdated data-coupled with a lack of clear guidance from leading agencies-have created a healthcare scenario rife with decisional conflict. As general practitioners frequently serve as patients' first point of contact within the US healthcare system, primary care is central to preconception and mental health management. This article educates primary care providers on the risks of untreated perinatal depression and the realities of antidepressant teratogenicity. Doubling as a narrative review, the article also synthesizes available evidence to provide a risk-based guide for treatment with antidepressants that emphasizes a shared decision-making approach.

Keywords: antidepressants; decisional conflict; maternal suicide; perinatal depression; shared decision-making; teratogenicity.