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2. The Concept of Satisficing
Vivien Burt, MD, PhD
The Women’s Life Center Resnick Neuropsychiatric Hospital at UCLA

3. Herbert Simon, behavioral economist
Simon, H. A. (1979). Rational decision making in business organizations. The American economic review, 69(4),
Picture

4. Satisficing Satisfy Sufficing
The optimal goal when forced to make a decision when much is unknown, unsure, or can never be fully known because of changing circumstances or other factors

5. Aim for a perfect outcome
A Different Approach
Past
Today
Follow the literature
Translate the data for our patients
No study is perfect
Aim for a perfect outcome
Imperfectly randomized
Numbers not that great
Many confounders

6. Discussing Satisficing
To choose among treatment options that will safeguard their health and optimize the health of their babies
Risk of speech delay (small) with medication
Serious depression (in the mother) without medication

7. Negative Maternal and Infant Outcomes Associated
with Depression in Pregnancy
Unable to care for themselves
Overwhelmed and anxious
Suicidal thoughts or attempts
Smoking
Drinking alcohol
Using drugs
Zuckerman, B., Amaro, H., Bauchner, H., & Cabral, H. (1989). Depressive symptoms during pregnancy: relationship to poor health behaviors. American Journal of Obstetrics & Gynecology, 160(5),
Gotlib, I. H., Whiffen, V. E., Mount, J. H., Milne, K., & Cordy, N. I. (1989). Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. Journal of consulting and clinical psychology, 57(2), 269. Suri, R., Altshuler, L. A., & Mintz, J. (2004). Depression and the decision to abort. American journal of psychiatry, 161(8),
O'hara, M. W., Neunaber, D. J., & Zekoski, E. M. (1984). Prospective study of postpartum depression: prevalence, course, and predictive factors. Journal of abnormal psychology, 93(2), 158.

8. Negative Maternal and Infant Outcomes Associated
with Depression in Pregnancy
Using multiple nonstudied 
medications
Ambivalent about pregnancy
Considering or electing abortion
Increased likelihood of
postpartum disorders
Zuckerman, B., Amaro, H., Bauchner, H., & Cabral, H. (1989). Depressive symptoms during pregnancy: relationship to poor health behaviors. American Journal of Obstetrics & Gynecology, 160(5),
Gotlib, I. H., Whiffen, V. E., Mount, J. H., Milne, K., & Cordy, N. I. (1989). Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. Journal of consulting and clinical psychology, 57(2), 269. Suri, R., Altshuler, L. A., & Mintz, J. (2004). Depression and the decision to abort. American journal of psychiatry, 161(8),
O'hara, M. W., Neunaber, D. J., & Zekoski, E. M. (1984). Prospective study of postpartum depression: prevalence, course, and predictive factors. Journal of abnormal psychology, 93(2), 158.

9. Medical and Obstetrical Complications
Depression in pregnancy increases the risk for:
Premature birth
Earlier deliveries
Postnatal complications
C-section
Poor neurobehavioral outcomes
Instrumental vaginal deliveries
Poor psychiatric and behavioral outcomes in the offspring
Smaller babies for gestational age
Zuckerman, B., Amaro, H., Bauchner, H., & Cabral, H. (1989). Depressive symptoms during pregnancy: relationship to poor health behaviors. American Journal of Obstetrics & Gynecology, 160(5),
Gotlib, I. H., Whiffen, V. E., Mount, J. H., Milne, K., & Cordy, N. I. (1989). Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. Journal of consulting and clinical psychology, 57(2), 269. Suri, R., Altshuler, L. A., & Mintz, J. (2004). Depression and the decision to abort. American journal of psychiatry, 161(8),
O'hara, M. W., Neunaber, D. J., & Zekoski, E. M. (1984). Prospective study of postpartum depression: prevalence, course, and predictive factors. Journal of abnormal psychology, 93(2), 158.

10. Key Points
Depression during pregnancy carries significant morbidity for the expectant mother and her developing fetus.
Clinicians should provide patients with reasonable options for treatment during pregnancy, supported with evidence-based data that are clearly presented and discussed.
No decision on whether to use psychiatric medications in pregnancy is risk free.
Patients ought to be encouraged to choose the treatment options that they can live with comfortably. That is the point of satisficing.

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