Page 31 - JCBP-2-3

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

Table 1. (Continued)
No. Consideration/risk description
7 Monitoring
Pregnant patients taking psychotropic drugs should receive close monitoring throughout pregnancy, including regular assessments of the
mother’s mental health and fetal development. Routine ultrasound scans and blood tests should be performed (as is the case for every pregnancy
– offered at 18-20 weeks in Australia); however, additional or more frequent consultations to assess the effectiveness of prescribed medications and
their level of symptom control is recommended. If an infant is suspected of being exposed to a psychotropic antenatally, consider the need for
observation in the initial postpartum period. 13
8 Patient education and informed consent
Pregnant patients must receive comprehensive information about the potential risks and benefits of taking psychotropic drugs during pregnancy.
They should be active participants in the decision-making process and provide informed consent. 3
For consent to be valid, it must be voluntary, informed, specific, current, and given by a person with capacity. To be informed, all relevant
information must be discussed with the patient. 16
As per the case of Rogers v. Whitaker, a doctor has a duty to warn a patient of any material risk involved in a proposed treatment. This principle
17
of informed consent would be applicable to both new prescriptions and deprescribing.
The High Court of Australia has considered the following factors in deciding whether a risk is “material,” thus requiring discussion with a
patient:
• The nature of the matter: If harm is more likely or serious, it requires disclosure;
• The nature of the proposed procedure/treatment: complex interventions require more information;
• The patient’s desire for information: patients who ask more questions or make their desire for information known should be informed;
• The temperament and health of the patient: Patients with existing health issues or relevant circumstances that make a risk more important for
them (e.g., pregnancy) may require more information;
• The general surrounding circumstances 16,18
Consent should be appropriately documented. Decision aids/written materials can be utilized where appropriate.
19
9 Timing of medication initiation and discontinuation
In some cases, it may be advisable to adjust the timing of medication initiation or discontinuation to minimize fetal exposure during critical
developmental periods. For example, possible teratogenicity caused by benzodiazepines in the first trimester. 20
10 Consideration of alternative treatments
Non-pharmacological treatments, such as psychotherapy, neurostimulation, and lifestyle modifications, may be explored as potential alternatives
or complements to medication. Psychotherapy and counseling interventions, often used without prescription or referral, may prevent the
11
progression of symptoms or clinical presentation altogether.
Note: The checklist has been formulated by consulting Frayne et al., Desai et al., Alsdorf and Wyszynski, Tuccori et al., Boyce and Buist, Wang and
Cosci, Jefferies, Ward and Zamorski, Coffman and Ash. 3,8-20
Abbreviations: SSRI: Selective serotonin reuptake inhibitors; TCA: Tricyclic antidepressants.

practitioner. This checklist has been developed as an 5. Conclusion
aide-memoire to prompt consideration of the myriad and
intricate aspects associated with prescribing. Decisions The prescription of psychotropic drugs to pregnant
women diagnosed with mental health conditions entails
pertaining to the prescription of psychotropic drugs multifaceted challenges and considerations. Striking a
during pregnancy must be tailored to the individual, critical balance is imperative, as it involves managing the
encompassing factors such as the patient’s medical and mother’s mental health while minimizing potential risks
psychiatric history, the severity of their condition(s), and to the developing fetus. The decision-making process
the range of available treatment options, which may extend is intricate, shaped by factors such as the teratogenic
beyond medication use. 5,11,15
potential of specific medications, the risk of neonatal
It is vital for psychiatrists to maintain open and honest withdrawal syndrome, and the potential for adverse health
communication with their pregnant patients and involve outcomes in both maternal and fetal contexts if psychiatric
them in a shared decision-making process to ensure the conditions are left untreated. 12,13,20 It also emphasizes the
best possible outcome for both mother and baby. Frayne importance of a collaborative approach involving various
3,15
et al. discussed that decision-making among pregnant health-care professionals, informed patient consent, and
women, including those with “anxiety and depression, is individualized treatment plans that may include medication
most strongly influenced by health practitioners, family, adjustments and consideration of non-pharmacological
and the internet.” 3(p384) Accordingly, there may be many treatments. 14,15 Pre-conception counseling plays a very
more factors and elements outside of the doctor–patient helpful role if it is an available option. The benefits of
relationship influencing the decision that shall require referring to maternal-fetal medicine services where
careful evaluation by the treating practitioner. appropriate can also prove advantageous. This paper is

Volume 2 Issue 3 (2024) 4 https://doi.org/10.36922/jcbp.2978