Psychiatric Meds Update

In the April issue of The Carlat Psychiatry Report there were two great updates on medication and pregnancy:

Leslie Hartley Gise, MD, Clinical Professor of Psychiatry at the University of Hawaii (and an expert on this subject for as long as I’ve been studying it) wrote a helpful article titled, “Prescribing Medications during Pregnancy and Breastfeeding.” Many clinicians who read this blog contact me for updated information regarding this ever-changing issue.

Here are some of her soundbites that I think they are extremely valuable for any clinician treating perinatal mood disorders:

1) “Every patient requires and individual risk/benefit analysis.”

2) “Try to avoid any medications during the first trimester of pregnancy.”

3) “My favorite medication for depression or anxiety in pregnancy is sertraline (Zoloft).”

4) “If a patient on medication discovers that she is pregnant, I always try to reduce the dose of medication.”

5) “I recommend continuing SSRIs until delivery.”

6) “My plan A for all patients on mediation is to not breastfeed; Plan B is to use sertraline (Zoloft) over other antidepressants.”

The other article was “Psychotropics and Pregnancy: An Update.” Here are highlights:

1) “A new study is reassuring on atypicals” (suggests that Zyprexa, Seroquel and Risperdal are relatively safe.)

2) “The Chambers study links SSRI use with persistent pulmonary hypertension of the newborn(PPHN) and “discovered that infants with PPHN were six times more likely than unaffected infants to have been exposed to SSRIs in the second half of the gestation.” They translate this into numbers: “The baseline population risk of PPHN is about 1.5 out of 1,000 births. Thus, if Chambers’ estimate of a sixfold relative risk is accurate, about one out of a hundred, or 1%, of SSRI-exposed babies would be expected to develop PPHN.” (!) (my exclamation point)

2) “Paxil is now the SSRI to avoid.” (citing risks of congenital heart defects)

3) “Lithium may be safer than previously thought.”

4) “Valproic acid is even more hazardous than previously thought.”

5) “Lamictal may cause cleft palate.” (“has been thought to be one of the safer treatments of bipolar disorder in pregnant women.”)

6) “There is nothing new to report on benzos.” (risk of cleft palate may be doubled from baseline rate of one to two in 1,000.) “Using relatively low doses of shorter half-life agents (e.g. 0.5mg lorazepam or alprazolam ) is likely to minimize this risk.”

7) Omega-3 does seem to be associated with “more intelligent kids” (higher IQs) (more than three servings per week)

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