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Advances in Psychiatric Treatment (2004) 10: 59-66
© 2004 The Royal College of Psychiatrists

Psychotropic medication in pregnancy

Dora Kohen

Dora Kohen is Professor of Women’s Mental Health at the Lancashire Postgraduate School of Medicine and Health (Leigh Infirmary, Leigh, Lancashire WN7 1HS, UK. E-mail: dorakohen{at}doctors.org.uk) and a consultant psychiatrist in perinatal psychiatry in Lancashire. Her interests are psychiatric services for women, and motherhood and severe mental illness.

The risks and benefits of psychopharmacological treatment in pregnancy need careful consideration. Conventional antipsychotics and tricyclic antidepressants are relatively safe for the foetus. Selective serotonin reuptake inhibitors appear to be safe, but mood stabilisers such as lithium, sodium valproate and carbamazepine are associated with increased foetal malformations. Benzodiazepines in the first trimester are teratogenic, and in high dosage can also cause withdrawal symptoms, hypotonia and agitation in the newborn. Women taking atypical antipsychotics should be switched to conventional antipsychotics before they conceive. In women with long-term mental illness necessitating psychotropic medication, effort should be made to stop polypharmacy and non-essential medication (e.g. benzodiazepines) and to decrease the dose of essential drugs, after full assessment. There is rarely a valid reason to stop essential drug treatment during pregnancy.




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