Lithium Exposure In Utero—How Bad Is It Really?

Topics: Bipolar Disorder | birth defects | Lithium | perinatal | postpartum mood | Pregnancy | women

REVIEW OF: Fornaro M et al, Am J Psychiatry 2020;177(1):76–92 STUDY TYPE: Literature review Most of us are wary of prescribing lithium to pregnant patients, but is prenatal lithium exposure as risky as we think? A meta-analysis of 13 case-control, cohort, and interventional studies (n = 1,349,563 pregnancies) compared congenital anomalies among

Capacity Assessment in Pregnant Patients

Topics: Aid to capacity evaluation (ACE) | Capacity | Pregnancy | Surrogate decision-maker

CHPR: In your current roles, you grapple with complex clinical situations, and one that is particularly difficult involves the treatment of pregnant mentally ill women who lack capacity to make decisions regarding obstetric care. Can you tell us how you approach these patients? Dr. Syed: We start with understanding that a patient doesn’t necessarily

Breast-feeding and Antidepressants: An Update

Topics: Antidepressants | Pregnancy | SSRIs

There’s nothing like a close friend suffering psychiatric difficulties to motivate a psychiatrist to do some serious reading. Recently, your humble editor encountered this situation. The patient is a young woman with no psychiatric history who noted more than a normal amount of anxiety after the birth of her child. She found herself worrying consta

SSRIs in Pregnancy: Third Trimester Concerns

Topics: Pregnancy | SSRIs

You may not know it, but this year marks a milestone in the world of SSRI teratology research. Ten years ago, JAMA published the first controlled study of Prozac exposure in pregnancy (1). The results? Neither Prozac nor tricyclics caused more birth defects than controls, but both antidepressants caused more neonatal complications. Ten years later, w

Dr. Victoria Hendrick on Using Meds in Pregnancy

Topics: Antidepressants | Pregnancy | SSRIs

TCR: Dr. Hendrick, there has been a lot of confusing and seemingly contradictory data about the safety of SSRIs during pregnancy. What’s your take? Dr. Hendrick: You’re right, it is confusing, but one reassuring and important point is that there is no evidence that the SSRIs or any other antidepressant are linked to an increased risk of congenital

An OB/GYN Perspective

Topics: Antidepressants | Pregnancy | SSRIs

Roseann Gumina, M.D., is an obstetrician/gynecologist in private practice in Milwaukee, Wisconsin. Like most OB/GYNs, Dr. Gumina sees more pregnant women on antidepressants in a given year than most psychiatrists are likely to see in a lifetime, and her perspective is informative. “Generally, most women who have been on SSRIs will have already disc

Unintended Pregnancies in Opioid Use Disorder

Topics: contraceptive services | Medication for Opioid Use Disorder | Opioid Use Disorder | Pregnancy

REVIEW OF: Heil SH et al, JAMA Psychiatry 2021;78(10):1071–1078 STUDY TYPE: Randomized controlled trial Among women with opioid use disorder, nearly eight out of every 10 pregnancies are unintended (Fischbein RL et al, Contracept Reprod Med 2018;3:4). The complications and potential adverse outcomes of these pregnancies include neonatal opioid w

The Pregnant Patient With Substance Use Disorder

Topics: Addiction Treatment | fetal effects | Pregnancy

CATR: Could you tell us what your role is and what you do? Dr. Forray: I’m an associate professor of psychiatry at Yale and I do research on treatments for pregnant and postpartum patients with substance use disorders (SUDs). Clinically, I’m the interim chief of the Section of Psychological Medicine at Yale New Haven Hospital and work with patients

Buspirone: Still Effective After All These Years?

Topics: Anxiety | Anxiety Disorder | Benzodiazepines | Buspirone | GAD | Generalized Anxiety Disorder | Lavender | Medication | Melatonin | Pharmacology | Pregnancy | Psychopharmacology | Silexan

When buspirone was released in 1986, it was advertised as providing “a different kind of calm.” Unfortunately, physicians and their patients weren’t ready to accept the kind of calm that required several weeks to take effect, when punchier, quicker benzos were the standard route to tranquility. Although buspirone is FDA approved for generalized an

Brexanolone (Zulresso) for Postpartum Depression

Topics: Depression | Depressive Disorder | Pharmacology | Postpartum Depression | Pregnancy

On March 19, 2019, the FDA approved brexanolone (Zulresso), the first medication for postpartum depression (PPD). Delivered by intravenous injection, brexanolone is an analogue of the hormone allopregnanolone. Allopregnanolone levels fall abruptly after childbirth, which is thought to contribute to PPD by destabilizing GABAA receptors. We covered brexa

What Can Our Pregnant Patients Do to Prevent Mental Illness in Their Children?

Topics: Practice Tools and Tips | Pregnancy

TCPR: Expectant mothers often want to come off psychiatric medications. From their perspective, mental illness takes place in the brain and won’t affect the fetus, while psychiatric medications are quite dangerous. What can we tell them?Dr. Freedman: There are risks with psychiatric medications, but the only one that is contraindicated in pregnancy