Psychopharmacology and Pregnancy: Treatment Efficacy, Risks, and Guidelines 2014

1. Introduction: Pharmacological Treatments of Mental Disorders in Pregnancy

Megan Galbally , Andrew J. Lewis2 and Martien Snellen1


Perinatal Mental Health, Mercy Hospital for Women, 163 Studley Rd, Heidelberg, 3084, VIC, Australia


Faculty of Health, School of Psychology, Deakin University, Burwood, Australia

Megan Galbally




This book provides an overview of the latest research and clinical practice recommendations for the use of psychopharmacology in pregnancy. Authors include leading researchers and clinicians in this field from across the globe with a focus on how the latest research findings can be translated into clinical care.


PsychopharmacologyPregnancyMaternal mental illness

This book brings together experts from around the globe in the area of pharmacological treatment of mental disorders in pregnancy. In addition to chapters which focus on the treatment of specific mental disorders this book has included chapters which focus on the broader and highly relevant issues, such as informed consent, that face clinicians and researchers in examining treatment for perinatal mental illness. As the implications of maternal mental illness for maternal and fetal well-being become apparent, perinatal mental illness has become a focus for those working in mental health, obstetric and maternity care, pediatrics, and primary health care.

There is much room for optimism in the field of perinatal mental health. There is now a substantial improvement in the awareness and detection of mental disorder over pregnancy. The public awareness of postnatal depression in particular has grown substantially in the light of increasing media awareness, high profile members of the public discussing their experiences, and mental health promotional activities. There are also significant advances in population screening for high prevalence disorders such as depression and anxiety in pregnancy and in the postpartum. Traditional and religiously inspired views about mother’s mental health over pregnancy have been replaced with scientific accounts of the no less miraculous processes of fetal development, and the profound interplay between maternal and fetal biology is increasingly a focus of research.

And yet there remain significant challenges in the psychiatric field, particularly in terms of the provision of adequate services to all members of the public and across both developed and developing countries. Also in terms of the availability of effective interventions targeted to those who are likely to benefit the most.

Alongside the increasing awareness of maternal mental health conditions over pregnancy, there have been increases in antidepressant prescription rates in countries such as Canada, the USA, and Denmark (Andrade et al. 2008; Cooper et al. 2007; Oberlander et al. 2006; Jimenez-Solem et al. 2013), although studies also suggest that many women precipitously cease antidepressants upon becoming pregnant due to concerns about fetal well-being with one study showing up to 60 % ceased upon becoming pregnant (Ververs et al. 2006). A study of those women who abruptly discontinued their antidepressants found 70 % had adverse effects and 30 % became suicidal (Einarson 2005). A study specifically of relapse of depression in pregnancy found of those who continued to take their antidepressant medication only 26 % relapsed compared to 68 % who discontinued their treatment (Cohen et al. 2006).

While much of the focus of perinatal mental health research and clinical care is concerned with high prevalence disorders such as depression and anxiety. A focus on low prevalence disorders, such as schizophrenia and bipolar disorder, is emerging as evidence for high-risk pregnancies associated with both these conditions and the treatments used emerges. Antipsychotic medications, particularly the second generation, have increased in rates of prescription in the general population including women during the fertile period (Alexander et al. 2011). The increasing rate of use is attributed to a broadening of indications and common uses for these medications and hence understanding the risks and benefits of treatment in pregnancy is now relevant to conditions beyond bipolar disorder and schizophrenia.

Understanding the research basis upon which risks and benefits of antidepressant treatment are assessed is vital to accurately convey and translate the latest findings to women in this ever-growing field of literature. This book has therefore sought not just to provide comprehensive chapters on managing women in pregnancy with psychopharmacological agents but provide some of the essential background tools to allow ongoing appraisal of the literature. This includes the ethical and legal obligations around informed consent which in pregnancy takes on the added dimension of fetal and child well-being which is covered in this chapter. Understanding the principles of research methodology specifically to exposure research in pregnancy is essential to any appraisal of research findings and this is discussed in Chap. 2. The biological basis upon which concerns arise for exposure to psychotropic medication during fetal development and equally relevant an understanding of maternal mental illness as an exposure in its own right form Chaps. 3 and 4.

The remainder of the book systematically covers specific mental illnesses in pregnancy with a review of the current literature of risks and benefits of pharmacological treatment. This has deliberately been structured under the disorder rather than the treatment to keep a strong clinical focus and ensure relevance to day-to-day clinical care in pregnancy.

Each of these chapters is focused on a specific disorder and covers the natural history of the condition across the perinatal period. In addition, the chapters examine the evidence for the efficacy of drug treatments for that specific disorder in the perinatal period. This includes a discussion of the issue of study quality and replication as well as gaps in the evidence base. Special attention is paid to the potential dangers of different treatment options for both mother and fetus, covering risks of malformation, pregnancy and obstetric risks, neonatal risks, and possible long-term consequences.

The final chapters cover Complementary and Alternative treatments and ECT in pregnancy. Both are important areas of clinical care which can be indicated or requested treatments for mental illness in pregnant women.

This book is designed for a range of professionals and interested member of the public. The consideration of clinical risk vs. benefit of pharmacological treatment is also highlighted in each chapter. The emphasis throughout is on a collaborative model of care between treating clinicians and women and their families to seek the best outcomes in pregnancy. We have sought to ensure this book has wide relevance with an international focus and hence we have solicited papers from a wide range of clinicians and researchers across from around the globe.

The wide range of research covered in this book indicates the importance of perinatal mental health with implications for maternal, child, and wider family well-being. This book serves as a resource of current findings in this important area of health care but also serves as a lens to view future research in perinatal mental health.


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