Pregnancy and Mental Health

Question 1

safe and unsafe antidepressants in pregnancy

Answer 1

sertraline (safe in breast feeding)
citalopram/escilatopram (“)
fluxoetine

unsafe- paroxetine. (associated with cardiac malformations after high dose >25mg/day in first trimester)
venlafaxine- cardiac defect.

“the evidence accumulated over the past 2 decades points to the risk (if any) for birth defects associated with antidepressants to be acceptable compared with the risks of untreated or undertreated maternal depression”

blockade of serotonin may be associated with increased risk of postpartum haemorrhage

small increase risk of IUGR and LBW

Question 2

safe and unsafe antipsychotics in pregnancy

Answer 2

olanzapine
quietapine
(both are safe in breastfeeding)
*weight gain and gestational diabetes
aripiprazole

2nd generation are associated with low folate levels (folic acid supplementation 5mg/day)

1stgen- minimal risk of teratogenicity.

unsafe: cloazpine
used if necessary but under supervision. not safe for breast feeding

Question 3

safe and unsafe mood stabilisers in pregnancy

Answer 3

Olanzapine
Quetiapine
(both are safe in pregnancy)
Aripiprazole

unsafe: sodium valproate, carbamezapine

stop or switch lithium

sodium valproate is absolutely contraindicated in pregnancy and should not be prescribed.

lamotrigine- baseline plasma levels as soon as possible and every 4 weeks. not safe for breastfeeding

Question 4

anxiolytics in pregnancy

Answer 4

promethazine OK

benzodiazepines- only to be used short term.

propanolol OK

Question 5

antidepressant withdraw in neonates

Answer 5

mild and self-limiting
slightly reduced with fluoxetine due to it’s long half life

sleeping problems
tremor
constant crying
suckling problems
myoclonus

Question 6

hypnotics in pregnancy

Answer 6

or severe or chronic sleep problem
promethazine

zopiclone to be avoided in late pregnancy

Question 7

ADHD medications

Answer 7

methylphenidate

Question 8

substance misuse

Answer 8

nicotine replacement therapy is ok

alcohol- detoxification
chlordiazepoxide and diazepam

methadone and buprenoprhine for opiate dependency

Question 9

switching from fluoxetine to sertraline

Answer 9

reduce fluoxetine gradually over 2 weeks then wait 4-7 days (long half life so a washout period is recommended before starting another SSRI

in doses of fluoxetine of over 20mg, gradual withdrawal is recommended over two weeks