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

Herbert Simon, behavioral economist Simon, H. A. (1979). Rational decision making in business organizations. The American economic review, 69(4), 493-513. Picture https://www.datocms-assets.com/4857/1522134382-tumblr_mbfzvktybl1rr5swxo1_400.jpg

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

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

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

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), 1107-1111. 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), 1502-1502. 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.

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), 1107-1111. 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), 1502-1502. 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.

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), 1107-1111. 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), 1502-1502. 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.

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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