Mental Health Clinician Volume 3: Issue 2

The prevalence of depression among pregnant women has been estimated to be 7 to 19 percent. Untreated depression has been associated with poor outcomes for both the mother and neonate. Antidepressant use during pregnancy has been associated with similar outcomes. This review will evaluate the risks and benefits of antidepressant use during pregnancy and lactation.

Background: Bipolar disorder is a brain disorder that can cause abnormal changes in a person's mood, cognitive function, and quality of life. Patients who are diagnosed with bipolar disorder often have intense emotional states that are characterized by either manic or depressive episodes. There is a strong correlation between women of child bearing age and the initial age of onset of the disease. Mood stabilizing drugs have been the mainstay of treatment for many decades; however, there is strong data supporting the teratogenic effects of these drugs on the fetus in pregnant and lactating women.

Methods: Review articles, clinical trials, and practice guidelines were located using online databases PubMed, CINAHL, IDIS, and Medline. Search terms included at least one of the following: “bipolar disorder”, “breast-feeding”, “carbamazepine”, “epilepsy”, “lactation”, “lamotrigine”, “lithium”, “mood stabilizers”, “pregnancy”, “valproate”, and “valproic acid”. Online clinical databases Clinical Pharmacology and Lexi-Comp were also used in the study.

Results: All mood stabilizer drugs are found to cause malformations in fetal development if given during the first trimester of pregnancy, thus use should be avoided if possible. Lamotrigine was found to cause lowest risk of adverse effects in both the mother and fetus during pregnancy; however, it should be avoided in breastfeeding women as it readily passes into breast milk. Lithium use during pregnancy and lactation has been associated with severe malformations and should only be used if maternal benefit outweighs fetal risk. Valproate is considered harmful to both the mother and fetus during pregnancy, but may be a compatible option for breastfeeding. Carbamazepine is found to cause serious malformations with the developing fetus as well as metabolic effects with the mother; however, it is found to cause little effects in breastfed infants as it does not readily pass through breast milk.

Conclusion: The use of medications in pregnant and breastfeeding women suffering from bipolar disorder must be carefully considered for impacts on fetal development as well as risks to the mother. Mood stabilizers are readily marketed as first line treatment options for bipolar disorder; however, their use in pregnant and lactating women may cause limitations as preferred therapy. Studies show that though lamotrigine has not been as well studied as the other agents, it may be the best recommendation during pregnancy, for both fetal and maternal health concerns. For breastfeeding women, carbamazepine has been shown to be the better option, as it carries the lowest risk of adverse events to the infant.

Pregnancy screening and contraceptive counseling are essential components of treating female patients with psychiatric illness to avoid placing the mother or fetus at risk if pregnancy occurs during treatment. The primary objective of this study was to evaluate current practices for pregnancy and contraception screening in female veteran patients prescribed psychotropic medications at a Veterans Affairs/Department of Defense (VA/DoD) facility.

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Book: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

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This new edition of

A bump in the road: Overcoming fear associated with psychotropic treatment during pregnancy

Toolbox: Psychotropic use in pregnancy and lactation

Use of antidepressants during pregnancy and lactation

Oh baby! A review of mood stabilizers for bipolar disorder in the child-bearing woman

Comparing current practices of screening for pregnancy and contraceptive use in female veterans of child-bearing age prescribed psychotropic medications in a mental health versus a women's health clinic

FDA pregnancy categories: Help or hindrance?

Perinatal psychiatry: Innovative practice and transitions of care

Untreated psychiatric disorder in pregnancy: Weighing the risks

Contraception and prenatal vitamin supplementation for women on antiepileptic medications

Favorable pregnancy outcomes following continual intramuscular lorazepam use in late pregnancy

Antipsychotic use during pregnancy and lactation: optimizing health for mother and newborn

Book Review: Diagnostic and statistical manual of mental disorders, fifth edition

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