Psychiatric medication could be safe during pregnancy

Women who take medication to support their mental health have traditionally been advised to discontinue psychiatric medication during pregnancy. Newer studies suggest, however, that many such medications are safe for expectant mothers and their babies, reports Southern Courier.

Consequently, pregnant women and women who are trying to conceive are encouraged to consult their treating psychiatrist about their options for managing mental health conditions.

Dr Lavinia Lumu, a specialist psychiatrist practising at Akeso Randburg – Crescent Clinic, said: “In the past, it was believed that psychiatric medications were harmful to the unborn baby. However, more recent studies have demonstrated that some kinds of psychiatric medication can often be continued in pregnancy with relative safety.”

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“Stopping psychiatric medication during pregnancy can actually result in more harm, not only to the mother, but also to the baby. It is best for any woman who is taking psychiatric medication to consult their doctor to ensure that their medication is safe during pregnancy.

“New research is starting to show that left untreated, depression and anxiety result in an excess production of cortisol, a stress hormone, in the mother. The excess cortisol is able to cross the placenta, which is supposed to act as a protective filtering mechanism for the unborn baby, and may affect the foetus by slowing down brain development and overall growth during pregnancy,” Lumu explains.

“Foetuses exposed to high levels of cortisol are more likely to have difficulties after birth. There has been research that also suggests that babies who were exposed to untreated mental illnesses are at greater risk of developing mental illnesses themselves later in life.”

Lumu said antidepressants were relatively safe to take during pregnancy. However, it is imperative to consult an appropriate medical professional to establish any potential risks. Where there is any uncertainty about the safety of the specific medication, it is advisable to consult with both a specialist psychiatrist and the gynaecologist/obstetrician to establish the most appropriate course of action.

“There is a body of evidence to support the use of a specific class of antidepressants known as selective serotonin reuptake inhibitors [SSRIs] during pregnancy. Some research has indicated that some babies of mothers taking SSRIs during pregnancy may be born small for their gestational age or develop neonatal abstinence syndrome or persistent pulmonary hypertension of the newborn.

“It should, however, be borne in mind that many of the patients in the studies had other clinical factors that could have also have had an influence, which makes it difficult to attribute these risks to antidepressants alone.

“The potential risks of taking most kinds of antidepressants during pregnancy are relatively low, but should only be done, if required, after having consulted with a psychiatrist and gynaecologist/obstetrician.”

According to Lumu, a specialist psychiatrist should assess the patient to determine the use of antidepressants in pregnancy. The severity of the depression needs to be determined and the risks of not taking medication must be weighed against the benefits of taking medication.

“In some instances, mild to moderate depression can be managed without medication through psychotherapy with a psychologist, but it is always best to consult a psychiatrist,” she adds. There are many classes of medication to treat different mental health conditions.

The most common classes of medication used in pregnancy are:

• Antidepressants: SSRIs (selective serotonin reuptake inhibitors) are the safest class and have been the most researched. Examples include fluoxetine, sertraline, escitalopram and citalopram. Paroxetine, however, is not safe for use in pregnancy.

• Mood stabilisers: examples include lamotrigine and lithium. It should be noted that there is a 1:1,000 chance of Epstein’s anomaly in lithium-exposed infants. Sodium valproate is not safe in pregnancy.

• Antipsychotics: examples include haloperidol, risperidone, olanzapine and quetiapine. Most antipsychotics are relatively safe in pregnancy and are often used for their mood-stabilising properties in the treatment of a bipolar disorder.

• Eglonyl (sulpiride) is an older antipsychotic drug commonly prescribed by obstetricians/gynaecologists or other doctors for the treatment of postnatal depression and also for the stimulation of lactation. Despite its frequent use, it is not an antidepressant and therefore has poor efficacy in the treatment of depressive symptoms.

• It is important to note that benzodiazepines, “tranquillisers” and “sedatives” are not safe for use in pregnancy.

“If you find out that you are pregnant while taking antidepressants, it is recommended that you consult your specialist psychiatrist to determine whether you should continue with your medication, and also speak to your obstetrician/gynaecologist. Your doctor may change your prescribed treatment to another medication that is safer for you and your baby or modify the dosage of the medicine you are currently prescribed,” she advised.

“One should never stop the medication unless instructed to do so by an appropriate medical professional,” Lumu concluded.

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