Antidepressant Discontinuation During Pregnancy: Navigating an Ethical Dilemma and Understanding Patient Narratives

Abstract: Depression is a common disorder in the United States, affecting about 20% of women during their lifetime (1). Pregnancy is a period of substantial social and psychological shifts, leading to increased vulnerability (1,2). As a result, the percentage of pregnant women using antidepressants has been rising each year (3). While some studies link antidepressant use with a higher risk of fetal cardiac defects, untreated depression is also associated with several adverse maternal and fetal outcomes and postnatal depression (4).

The aims of this study are twofold. First, a retrospective chart review will compare patients who discontinued antidepressants with those who continued their antidepressant through a complete pregnancy. Variables including age, ethnicity, psychiatric drug, diagnosis, and others, will be compared to investigate differences between the two groups. Other variables such as changes in depression/anxiety scores, suicidal ideation, and substance abuse during pregnancy will also be evaluated. Finally, for patients who elected to discontinue their antidepressant, I will carefully analyze medical charts to study the physicians’ documented narratives, outline the patient's life story, understand the patients’ reasoning and identify common patterns/themes.

Second, I will investigate the dilemma physicians face about whether or not to inform patients about the rare risks of antidepressant use during pregnancy, considering principlism, disability ethics, feminist ethics, narrative ethics, physician-patient trust, medical uncertainty, cultural relativism, and socioeconomic factors. Ultimately, this study seeks to contribute valuable perspectives to inform ethical guidelines, professional standards, and future research in maternal mental health and medical uncertainty.