Dr. Bob's Psychopharmacology Tips

Medications in general during pregnancy

Date: Fri, 23 Feb 1996 21:04:17 EST
From: LHSQ76A@prodigy.com (Dr Valerie D Raskin)
Subject: Medications in general during pregnancy

I simply do not understand why so many of my colleagues feel free to state their concerns about the risk of teratogenecity without having bothered to look at the literature. The statement that teratogenecity is only a concern in the first trimester is uninformed, since the brain develops throughout pregnancy, and we have absolutely no meaningful data about behavioral teratogenesis secondary to our meds, which obviously affect neurotransmitters.

Therefore, we as physicians must always assist our patients in weighing the risks of untreated illness to the mother and fetus vs. the theoretical risks of the drug. Seriously ill patients may be expected to decompensate if unmedicated. If a woman emerges from her pregnancy with a less treatable illness, her fetus will suffer serious consequences. This is a real concern, unlike the theoretical possibility that a medication may cause an as yet undetected increase in birth defects.

Date: Mon, 26 Feb 1996 15:38:34 -0500 (EST)
From: Carol Ann Dyer <cadyer@gwis2.circ.gwu.edu>
Subject: Medication during pregnancy

I have had two patients with such severe symptoms that I worried about their clinical course without medication during pregnancy. I recommended that they stop meds -- clomipramine in one case, fluoxetine in the other -- and undergo a course of cognitive-behavioral therapy. Both had great outcomes with CBT and delivered healthy baby boys, and neither has resumed medication. They are living with low-level, manageable OCD symptoms.

From: MKomrad@aol.com
Date: Wed, 5 Mar 1997 22:27:30 -0500 (EST)
Subject: Medication during pregnancy

Here are three excellent review articles on the use of psychotropic drugs during pregnancy and lactation.

1. Goldberg HL, Psychotropic drugs in pregnancy and lactation. International Journal of Psychiatry in Medicine 24 (2), 129-147, 1994.

2. Stowe and Nemeroff, Psychopharmacology During Pregnancy and Lactation" in: American Psychiatric Press, Inc., Textbook of Psychopharmacology.

3. Altshuler LL, Cohen L, Szuba MP, Burt VK, Gitlin M, Mintz J, Pharmacologic management of psychiatric illness during pregnancy: dilemmas and guidelines. American Journal of Psychiatry 153: 592-606, May 1996.

I rely heavily on these references when I treat pregnant or lactating women.

Date: 28 Apr 96 18:23:47 EDT
From: Leslie Gise <76106.413@CompuServe.COM>
Subject: Medication during pregnancy

Yes, medicating pregnant women is is balancing the risks. Most pregnant women get either too much or too little medication. Either they are medicated as if they were not pregnant ... or they are denied medication from which they could benefit just because they are pregnant.

Date: 28 Apr 96 18:23:49 EDT
From: Leslie Gise <76106.413@CompuServe.COM>
Subject: Medication during pregnancy

What we can do better as psychiartists is assess the risk of pregnancy in any woman of reproductive age to whom we prescribe medication. Is she sexually active with men? Is she or her partner doing anything to prevent pregnancy? Are they doing it all the time? This should be part of the routine assessment.

From: BJSCHWARTZ@delphi.com
Date: Mon, 07 Apr 1997 19:55:27 -0400 (EDT)
Subject: Medication during pregnancy

There ia a "teratology hotline" in Utah that evaluates all meds in terms of conception and on through nursing. The number is (801) 328-2229. Call them once and they will give you a local number.

Date: Wed, 30 Apr 1997 15:50:00 -0600
From: CClarkMD <CClarkMD@concentric.net>
Subject: Medication during pregnancy

Pregnancy and psychotropics is often a very difficult issue that bears much thought, consultation, and careful discussion with the mother, the OB and the father (if involved). I have treated many patients in this position both privately and in community mental health centers. There are certain meds that raise many red flags due to fairly well documented teratogenicity. For me, the decision to medicate or to continue meds during pregnancy rests in several realms:

1. What is the diagnosis being treated?
2. What are the meds required or already on board to treat it?
3. What is the risk to the mother and fetus of no treatment?
4. What are the risks of treatment?

Date: 01 Jun 97 21:12:47 EDT
From: Leslie Gise <76106.413@compuserve.com>
Subject: Medication during pregnancy

It is always my first choice to get a woman off drugs if she is pregnant or breastfeeding, but it is a risk benefit decision. If the mental illness is too severe or too brittle or she starts to relapse when the dosage is slightly lowered, that influences the decision.

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