Psychotropic medications in pregnancy
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Psychotropic medications in pregnancy

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    Psychotropic medications in pregnancy Psychotropic medications in pregnancy Presentation Transcript

    • ‫د/ايهاب أمين خليفة‬‫إستشاري الطب النفسي والدمان‬
    • Psychotropic medications in pregnancyPregnancy can be a challenging timefor women with long-term mental disorders. While mental illness iscommon among women of childbearing period it can bring increaseddifficulties and risks during and afterpregnancy, such as birth complications.and a worsening of symptom
    • Golden rules in Psychotropic medicationsUse old and safe PsychotropicsBe Cautious from Anticonvulsants andBenzodiazepinesUse High potency instead of low potencyantipsychotics
    • Taking medication for these conditions canbe a cause of anxiety for both the patient .and her physicianThe pros and cons of medication to motherand baby need to be considered,alongside many other factors that impact on maternal and fetal wellbeing
    • Dr. Frayne recommends that”specialist opinion issought early and a multidisciplinary approachwith access to specialist care offered if possible.Continuity of care, especially in the context of atrusting therapeutic relationship, is optimal,“ she.addsShe says the treatment plan during pregnancyshould be based on the woman‘s current mentalstate and medication, as well as her history ofpast mental illness and previous treatment, andfamily history of mental illness duringpregnancy. Her support network, pregnancy-related fears, drug and alcohol use should also . .be considered
    • A recent study found that”medications withpotential for fetal harm“ were being takenby 16 percent of women treated fordepression. There is a lack of pregnancysafety data for many medications.However, stopping treatment suddenly isnot recommended as this can cause side .effects and possible relapse
    • For example, in the case of disorder, relapse is •often due to the discontinuation of preventivedrugs. Although mild manic episodes can bemanaged without drugs, severe manic episodesneed to be treated because the possibleconsequences of injury, stress, malnutrition,profound sleep deprivation and suicide couldpose more risk to the fetus than the side effects .of the drug
    • Lithium should be avoided in the first trimester •of pregnancy, whenever possible, as it has beenlinked to a small but significantly increased riskof birth defects, particularly of the heart. Thenormal maintenance dose should be re-established as soon as possible followingdelivery, or if lithium is the only medication thatcontrols symptoms, it can be re-introduced in .the second trimester
    • Other bipolar medications such as •carbamazepine )Tegretol( and sodiumvalproate )Depakote( also carry some risksof fetal malformation, but physicians maystill consider using these medications onthe minimum effective dose, alongside regular monitoring
    • For generalized anxiety disorder and panicdisorder, low-risk medications areavailable. As an alternative to drugs,patients should be offered cognitive .behavioral therapy as OCD, PTSD
    • The selective serotonin reuptake inhibitor)SSRI( antidepressant paroxetine )sold asSeroxat, Paxil( is not considered safeduring pregnancy. The prescribing information says,”Epidemiological studieshave shown that infants born to womenwho had first trimester paroxetineexposure had an increased risk of cardiovascular malformations
    • If a patient becomes pregnant while“ •taking paroxetine, she should be advisedof the potential harm to the fetus. Unlessthe benefits of paroxetine to the motherjustify continuing treatment, considerationshould be given to either discontinuingparoxetine therapy or switching to another “.antidepressant
    • Antidepressant medications cross the placental barrier •and may reach the fetus, but research has shown thatmost other SSRIs are safe during pregnancy. Birthdefects or other problems are possible, but they areveryrareTricyclic antidepressants and serotonin-norepinephrine •reuptake inhibitors )SNRIs( have not been found to haveany serious effects on the fetus, and have been safelyused thoughout pregnancy for many years. On the otherhand, monoamine oxidase inhibitors )MAOIs( have beenassociated with increased risk of malformations and may.)interect with drugs used in labour )e.g., meperidine
    • nevertheless, there have been reports of neonatal •withdrawal symptoms after the use of SSRIs, SNRIs, andtricyclics during late pregnancy. These include agitation,irritability, a low Apgar score )physical health at birth(.and seizuresBenzodiazepines should not be used during pregnancy, •particularly in the first trimester, as they may cause birthdefects or other infant problems. The U.S. Food andDrug Administration has categorized benzodiazepinesinto either category D or X meaning potential for harm inthe unborn has been demonstrated
    • If used in pregnancy, benzodiazepines witha better and longer safety record, such asdiazepam )Valium( or chlordiazepoxide)Librium(, are recommended overpotentially more harmful benzodiazepines,such as alprazolam )Xanax( or triazolam .))Halcion
    • Pregnancy outcomes for antipsychotic •medications vary widely depending on thetype of drug. Exposure to low-strengthantipsychotics during the first trimester isassociated with a small additional risk ofcongenital anomalies overall. Haloperidol)Haldol( has been found not to cause birth .defects
    • The National Institute of Mental Health • states,”Decisions on medication should bebased on each woman‘s needs andcircumstances. Medications should beselected based on available scientificresearch, and they should be taken at thelowest possible dose. Pregnant womenshould be watched closely throughout “.their pregnancy and after delivery