Psychopharmacological Treatment of Mood and Anxiety Disorders During Pregnancy
Many women with psychiatric disorders want to become mothers and only a minority seek advise prior to becoming pregnant. In those women, in whom pregnancy can be planned, the decision, if a medication is required for stabilisation and which one to choose
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Contents 1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 General Principles of Psychopharmacology During Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Reproductive Toxicity of Psychotropic Medication During Pregnancy . . . . . . . . . . . . . . . . . . 3.1 Antidepressants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.2 Mood Stabilisers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.3 Anticonvulsants and Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3.4 Benzodiazepines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Conclusions and Take Home Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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Abstract Many women with psychiatric disorders want to become mothers and only a minority seek advise prior to becoming pregnant. In those women, in whom pregnancy can be planned, the decision, if a medication is required for stabilisation and which one to choose if this is the case, is easier to make than in women in whom pregnancy occurs unplanned. The physician has to weigh the risk that a relapse of the psychiatric disorder during pregnancy poses to the foetus against the reproductive risk of psychotropic drugs. This presentation is intended to assist in understanding the general principles of pharmacotherapy during pregnancy as well as the morphological, perinatal and neurobehavioural toxicity of antidepressants, antipsychotics, benzodiazepines and mood stabilisers. Keywords Antidepressants • Antipsychotics • Benzodiazepines and mood stabilisers • Pregnancy
S. Kr€uger (*) Zentrum f€ur Seelische Frauengesundheit, Vivantes Humboldt-Klinikum, Am Nordgraben 2, 13509 Berlin, Germany e-mail: [email protected] V. Regitz-Zagrosek (ed.), Sex and Gender Differences in Pharmacology, Handbook of Experimental Pharmacology 214, DOI 10.1007/978-3-642-30726-3_14, # Springer-Verlag Berlin Heidelberg 2012
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1 Introduction Many women with psychiatric disorders want to become mothers, despite the wellknown risk of illness recurrence during and after pregnancy and despite the reproductive risks of psychotropic medications. The situation is even more complicated by the pregnancy-related hormonal changes which may produce unaccustomed mood swings and physical discomfort that may exacerbate existing psychiatric disorders or generate new
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