Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.

For pregnant women, or women recieving preconception care, with depression what are the comparative harms or benefits for both fetus/infant and the mother of continuing treatment with anti-depressants?

Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)

yes

If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:

Different classes of antidepressants, combination therapy of antidepressants, tapering treatment or switching therapies, CBT, other counseling

What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)

Pregnant women and women planning pregnancy who suffer from depression

Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)

mild, moderate, severe depression

Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)

mental health outcomes of the mother, prevention of post-partum depression

Describe any health-related risks, side effects, or harms that you are concerned about.

fetal harms- heart defects, preterm delivery, low apgar scores, admission to neonatal care unit, fetal growth

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?

yes

Which priority area(s) and population(s) does this topic apply to? (check all that apply)

EHC Priority Conditions (updated in 2008)

• Depression and other mental health disorders
• Pregnancy, including preterm birth

AHRQ Priority Populations

• Low income groups
• Minority groups
• Women

Federal Health Care Program

• Medicaid
• Medicare

Importance

Describe why this topic is important.

Between 10-20% of women experience depression during pregnancy and use of antidepressants in the population have increased.

What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)

As a womens mental health counselor I encounter many women who exprience depression during pregnancy or fear going off their treatment during pregnancy, they have recieved different advice from different sources and are confused about the trade off between benefits and harms. Many women feel that treating their depression during pregnancy is "selfish" because of the potential harms for the fetus and this causes feelings of guilt and anxiety.

Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)

yes

If yes, please explain:

See Kuehn JAMA December 2009

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?

Help inform care of these women

Describe the timeframe in which an answer to your question is needed.

unknown

Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.

Nominator Information

Other Information About You: (optional)

Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)

Help inform care of these women

Are you making a suggestion as an individual or on behalf of an organization?

Individual

Please tell us how you heard about the Effective Health Care Program

Website