Prescription of psychotropic drugs during pregnancy and breast-feeding in the general practitioner’s surgery.

Overview

The decision to prescribe drugs to treat patients with mental health problems is based on animal studies, case-reports, reports of adverse effects, registries of pregnant patients, or epidemiological studies. On the one hand, one must consider the consequences to the fetus or neonate of drug administration and, on the other hand, the negative impact of an untreated mental health disorder on the mother or child must be taken into account. Psychotherapy or electroconvulsive treatment are alternative options to pharmacotherapy. The most serious side-effects of drug treatment to the fetus and newborn include congenital malformations, intoxication and withdrawal syndromes and long-term neurobehavioral problems. Withdrawal of the maintenance medication can result in an increased risk of relapse, unfavorable course and overall outcome of the mother’s illness. With untreated illness, the fetus and child can be endangered through insufficient maternal care. The general practitioner frequently sees patients with mental health problems in his/her surgery, and commonly prescribes psychotropic drugs. Therefore it is essential to become familiar with the principles of drug treatment in pregnancy and breast-feeding, to know the risks and alternatives. This review summarizes data on the relationship between pregnancy and psychotic disorders, depression, bipolar disorder, and anxiety disorders. Teratogenesis is discussed in detail, as are other negative consequences of the various psychotropics, antipsychotics, antidepressants, mood stabilizers, anxiolytics, and hypnotics on the fetus and neonate during pregnancy and breast-feeding. Basic principles of drug treatment of mental disorders during pregnancy and breast-feeding are reviewed.

Key words:
pregnancy, breast-feeding, mental health problems, psychotropics, congenital malformations