Management of psychotropic drugs during pregnancy

Abstract

Psychiatric conditions (including substance misuse disorders) are serious, potentially life threatening illnesses that can be successfully treated by psychotropic drugs, even during pregnancy. Because few rigorously designed prospective studies have examined the safety of these drugs during pregnancy, the default clinical recommendation has been to discontinue them, especially during the first trimester. However, in the past decade, as more evidence has accumulated, it seems that most psychotropic drugs are relatively safe to use in pregnancy and that not using them when indicated for serious psychiatric illness poses a greater risk to both mother and child, including tragic outcomes like suicide and infanticide. This review presents an up to date and careful examination of the most rigorous scientific studies on the effects of psychotropic drugs in pregnancy. The lack of evidence in several areas means that definite conclusions cannot be made about the risks and benefits of all psychotropic drug use in pregnancy.

Treatment With Antipsychotics in Pregnancy: Changes in Drug Disposition

“…On the other hand, abstaining from treatment puts the mother at risk of a worsened psychiatric condition, with the dangers this involves for the mother and child. Weighing these options against each other, the recommendation has often been to discontinue treatment, especially during the first trimester 1. However, during the past decade more safety data have accumulated suggesting that antipsychotics are relatively safe to use in pregnancy 1, 2, 3.…”

“…Weighing these options against each other, the recommendation has often been to discontinue treatment, especially during the first trimester 1. However, during the past decade more safety data have accumulated suggesting that antipsychotics are relatively safe to use in pregnancy 1, 2, 3. It has also been demonstrated that discontinuing ongoing maintenance treatment for severe mood and psychotic disorders during pregnancy carries a high risk of disease recurrence 2.…”

Akılcı ilaç kullanımı ilkeleri doğrultusunda diş hekimliğinde kişisel analjezik listesi oluşturulması

“…Dünya genelinde bu yönde farklı sınıflandırmalar bulunsa da bunların en bilineni Amerikan İlaç ve Gıda İdaresi (Food and Drug Administration-FDA) başlattığı risk sınıflandırma sistemidir. Bu sınıflandırmaya göre risk "A, B, C, D ve X" kategorilerine ("A" en düşük, "X" ise en yüksek) ayrılır (40). Örneğin, NSAİİ'lerin gebelik kategorisi hamileliğin 1. ve 2. trimesterinde "C" iken son trimesterinde "D"dir (41).…”

Management of perinatal depression with non-drug interventions

“…Multiple organizations, including the American College of Obstetricians and Gynecologists,3 American Academy of Pediatrics,4 and most recently the US Preventive Services Task Force,5 have all recommended screening for perinatal mood disorders during pregnancy and post partum. Many different treatment options now exist for women who are diagnosed as having perinatal depression, including psychopharmacologic interventions, such as antidepressants and psychotherapeutic treatments 67…”