Page 29 - JCBP-2-3

Journal of Clinical and
Basic Psychosomatics Safe psychotropic drug use: Pregnancy checklist

Often, this medication has been prescribed after pregnancy of the maternal mental health condition should effective
rather than during, when it may have been appropriate. psychiatric medication be altered or ceased. Such
3
Frayne et al. discussed that pregnant women possess changes can pose their own set of risks to both maternal
a “dual role as both persons with a diagnosed mental and fetal health, which may potentially be more severe
illness but also new mothers, with many options causing than those associated with continuing treatment.
conflict.” 3(p385) This assessment accurately captures the Abrupt discontinuation of psychotropic medication can
dilemma that arises when deciding whether to continue precipitate withdrawal symptoms and an undesirable
with medication to treat the mother’s illness or potentially rebound of psychiatric symptoms, both of which can
cease or replace medication in the interests of their child. have deleterious effects on the pregnancy. Therefore, the
3
Psychiatrists, general practitioners, and other mental decision to continue or modify psychotropic medication
health professionals encounter challenges characterized during pregnancy requires a careful assessment of these
by competing interests, varied agendas, and occasionally risks against the benefits of maintaining maternal mental
conflicting or evolving medical safety data. This complexity health stability.
renders the risk-to-benefit assessment of prescribing
decisions a challenging undertaking. The burden of 3. The art of prescribing
1-3
the mother’s mental illness and depressive cognitions can In cases where the benefits of continued treatment with
further complicate this issue. psychotropics outweigh the potential risks, a psychiatrist
Prescribing anti-depressants and anti-psychotics may opt to maintain medication, sometimes adjusting
during pregnancy is scarcely covered by Australian Medical dosages, to ensure optimal health and well-being for both
Curricula. A recent submission from the Medical Student the mother and the developing fetus. Interestingly, the
4
Council of Victoria highlighted that “the proportion therapeutic guidelines note that their recommendations are
of teaching on mental health and its management is based on evidence of low-to-moderate quality and that data
disproportionately low given the burden of disease it poses on psychotropic safety is limited to observational studies
5
in Australian society.” 4 (p1) with substantial confounding factors. This complexity
further convolutes the process for the prescriber. There is
Psychiatrists who regularly prescribe medications for no treatment that is risk-neutral or universally applicable
pregnant patients demonstrate proficiency in the process. for a pregnant patient with a mental health condition.
However, professionals in related fields or within medicine,
which intersect with mental health, may derive advantages Childbirth can trigger a relapse of bipolar disorder
from a more systematic approach to underscore critical in 37% of women with the condition. This figure rises to
areas of concern that should not be overlooked. The 66% if the women are unmedicated and 23% if they are on
6
prescribing landscape during pregnancy encompasses as prophylactic medication. In a recent Australian survey of
many risks as benefits, with numerous uncertainties to pregnant women, 25% of participants screened positive for
navigate. Nevertheless, practitioners should possess the depression, 19% for moderate or higher-range anxiety, and
7
requisite knowledge to feel confident in sustaining the 15.5% for stress. There is a significant mental health burden
prescription of most medications throughout pregnancy. 3 among pregnant women not only in Australia but globally.
There is a paucity of recent comparison data between child-
2. The balancing act: To prescribe or bearing and non-child-bearing women. Nevertheless, it is
deprescribe? essential to have a framework in place to assist in safely
prescribing for the child-bearing demographic.
Prescribing psychotropic drugs to pregnant patients
is a complex and delicate undertaking that requires Accordingly, a 10-point checklist (Table 1) has been
meticulous consideration of potential risks and benefits. constructed to outline considerations and key risks for the
The paramount concern for most medical practitioners prescribing practitioner to assess when deciding whether
when prescribing for pregnant patients revolves around to prescribe psychotropic agents during pregnancy. This
teratogenic or other harmful effects on the fetus. Neonatal checklist does not explore the risks associated with specific
withdrawal syndrome, exemplified by its occurrence agents, which should be researched individually when
with selective serotonin reuptake inhibitor use, is also commencing prescribing.
a significant issue, as is the use of drugs that cross the
placental barrier. Furthermore, some psychotropics are 4. Practical considerations
associated with an increased risk of low birth weight or It is imperative to maintain awareness that each case
premature birth. However, these risks must be carefully is inherently unique, and this guide does not serve as
2
balanced against the possibility of relapse or exacerbation a substitute for the clinical judgment of the treating

Volume 2 Issue 3 (2024) 2 https://doi.org/10.36922/jcbp.2978