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A patient decision aid for antidepressant use in pregnancy: a Canada-UK collaboration

Around 10% of women experience depression in pregnancy. Antidepressant medication may be the treatment of choice for women with moderate to severe depression. Women who might benefit from continuing or starting an antidepressant during pregnancy face a difficult decision. This is because both depression itself and the antidepressant medications used to treat it can carry risks for the mother and her unborn child. 

It has been shown that routine clinical care and the provision of information on the benefits and harms of antidepressant use in pregnancy do not always allow women to make a choice that they feel satisfied with, and that is in line with their values. 

In other fields of medicine, patient decision aids (PDAs) are used to make this process easier. A PDA is a tool that allows patients to (a) access information about an illness and its treatments, (b) clarify the decision that they have to make and (c) clarify their personal values and preferences in relation to that decision. There are no existing up-to-date PDAs on the use of antidepressants in pregnancy. 

Dr Simone Vigod and her colleagues, from the University of Toronto in Canada, have developed an electronic, evidence-based PDA on antidepressant use in pregnancy. The PDA can be accessed electronically by a patient at home or in the clinic, and is designed to be used flexibly alongside usual clinical care. The PDA is currently being tested by patients who are considering using an antidepressant in pregnancy, to assess how acceptable and useful it is to patients and their clinicians. 

These pilot trials will be conducted in Canada and in the UK (in patients accessing SLAM services). Findings from these acceptability and feasibility trials will be used to design a large international randomized controlled trial (RCT), which will assess how effective the PDA is. 

Specifically, it will assess whether the PDA reduces the conflict that women feel in relation to decisions about antidepressant use in pregnancy. The trial will also assess whether the PDA improves patients’ knowledge on treatment options, patient-clinician interactions and the likelihood of women suffering from postnatal depression and anxiety. The PDA is a relatively simple, low-cost intervention with the potential to help a significant number of women and unborn children. The pilot and future planned trials will ensure that is rigorously evaluated.

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