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Psychiatric Disorders and Medications

Depression, anxiety, and other psychiatric disorders are common in women of reproductive age. If you're living with one of these disorders and taking a medication to control it, you may be wondering if you need to stop taking that drug to have a healthy baby. There is no simple "yes" or "no" answer.

Antidepressants. Depression affects up to 25 percent of adults in the United States each year, and women are twice as likely as men to experience it. The onset of major depression tends to occur during the childbearing years, and pregnancy appears to neither promote nor protect against it. Based on years of using antidepressants, physicians may give the green light to pregnant women to use tricyclic antidepressants (Elavil, Norpramin, Pamelor, and others) and SSRIs (selective serotonin reuptake inhibitors) like Prozac and Zoloft. Other medications may be less appealing because they can harm the baby's development.

Mood stabilizers. Lithium, valproic acid (Depakoate), and carbamazepine (Tegretol) are common treatments for bipolar disorder. Unfortunately, all of these drugs are linked to a higher risk of miscarriage and birth defects. For instance, valproic acid and carbamazepine have both been associated with a tenfold increase in neural tube defects if taken during the 1st trimester.

Antipsychotics. There are three basic groups of antipsychotics: high-potency agents, low-potency agents like Thorazine (chlorpromazine), and newer drugs like Risperdal (risperidone), Clozaril (clozapine), and Zyprexa (olanzapine). Each of these drugs has been linked to various fetal effects if taken during the 1st trimester.

If you have a psychiatric disorder, it is important to discuss it with your provider. Psychiatric symptoms can hamper your pregnancy if they affect your emotional state, your ability to take care of yourself, and your potential to engage in harmful behavior. You and your provider can weigh the risks and benefits of using specific medication during pregnancy. For instance, how well did you function without it before you were pregnant? Do you have a history of psychiatric hospitalizations or suicide attempts? Are you likely to have self-destructive thoughts if you stop taking this drug? Is there another effective medication that's safer to take during pregnancy? Discuss your concerns with your practitioner and mental health provider.

Originally published in You & Your Baby: Pregnancy.

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