Antidepressants, Antipsychotics, and Mood Stabilizers in Pregnancy: What Do We Know and How Should We Treat Pregnant Women with Depression

Abstract

Depression is generally treated with antidepressants, but may often need antipsychotics and mood stabilizers. We discuss the updated data regarding the safety in pregnancy of antidepressants and antipsychotics, except selective serotonin reuptake inhibitors, and their possible impact on the long-term development of the offspring. Several earlier studies demonstrated a slight increase in the rate of major anomalies following maternal tricyclic antidepressant treatment, but most current literature shows their relative safety in pregnancy. Data on the development of the offspring are also reassuring. The antipsychotic drugs are also safe for the developing fetus and do not seem to induce developmental delay. Both groups of drugs may cause perinatal withdrawal symptoms and difficulties in neonatal adaptation. The mood stabilizers, lithium, and several anti-epileptic drugs, may adversely affect the developing embryo and fetus. While valproic acid, carbamazepine, and topiramate are teratogenic and may also affect postnatal development, the newer antiepileptic and mood stabilizers, lamotrigine and levetiracetam, seem to be safe in pregnancy and apparently have no long-term neurodevelopmental damage. Lithium may increase the rate of cardiac anomalies, especially of Ebstein's anomaly, and may warrant a mid-trimester fetal echocardiography. Although data on the development of the offspring are reassuring, we should remember that most studies were carried out during early childhood, at a time when inattention, learning difficulties, behavioral and psychiatric problems are not yet identifiable. When considering medical treatment for depression in women at child-bearing age, we have to weigh the severity of the symptoms and their impact on the developing fetus and child. Birth Defects Research 109:933-956, 2017.© 2017 Wiley Periodicals, Inc.

Fetal programming of neuropsychiatric disorders by maternal pregnancy depression: a systematic mini review

“…Antidepressant medication may offer an option as several reviews indicate the likelihood of serious harms is low. [12][13][14][15] Although, investigations into specific medications and classes of antidepressants [88][89][90] complicate the literature, suggesting serious harmful effects, leading many doctors not to prescribe and/or many women refuse/discontinue medication in pregnancy. 5 Until the data on the safety and efficacy of antidepressant therapies are clearly defined, efforts should be concentrated to assess alternative therapies.…”

“…SSRIs) maternal prenatal depression. [12][13][14][15] To the best of our knowledge, no reviews have focused specifically on the consequences of prenatal depression on offspring neuropsychiatric outcomes. Hence, the objective of this review was to assess all recent studies assessing prenatal depression and offspring neuropsychiatric outcomes.…”

Role of food-drug interactions in neurological and psychological diseases

“…Patients with depression and bipolar disorder are treated with a variety of psycho-pharmaceuticals. Among these pharmaceuticals are antidepressants, such as selective serotonin reuptake inhibitors, serotonin norepinephrine reuptake inhibitors, monoamine oxidase inhibitors, tricyclic antidepressants and a variety of antipsychotic drugs (Ornoy et al 2017, Yohn et al 2017.…”

“…Typical antipsychotics include: chlorpromazine, fluphenazine, haloperidol, loxapine, perphenazine, pimozide, thioridazine, thiothixene, trifluoperazine, and triflupromazine. The atypical antipsychotics include: aripiprazole, clozapine, olanzapine, quetiapine, and ziprasidone (Ornoy et al 2017).…”

Postpartum Psychiatric Disorders

“…A review of recent studies demonstrated that lamotrigine had no adverse outcomes on infant IQ or neurodevelopment. 211 The management of a breastfeeding woman with a severe psychiatric episode is challenging due to concerns about the exposure of breastmilk to pharmacological therapies and the need for sleep preservation in the mother 15 . The use of lactation inhibitors should be avoided.…”