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Dr. Paul LatimerWomen with psychiatric conditions enter into murky territory when it comes to making decisions about their treatment during pregnancy.

As a general rule, women are advised not to take any medications during pregnancy and for many this is not a big sacrifice. Forgoing the use of aspirin or cold medication might make for a couple of stuffed up days, but will probably not make much of a difference to the health of the mom-to-be.

Unfortunately, for women being treated with medications for psychiatric illnesses, the decision is not always as clear cut as it is for normally healthy individuals entering a pregnancy.

Psychiatric medications pose a dilemma because of the real risk of serious relapse or recurrence of dangerous psychiatric symptoms if medication use is stopped.

All new medications are tested on animals for general toxicity and the likelihood that they will cause congenital malformations in babies. For obvious ethical reasons, they are not tested on pregnant humans and there is limited information specific to the effects of most medications on pregnant women or their babies.

Existing data is the result of observations taken when a woman unknowingly or accidentally becomes pregnant while taking medication. Because this information does not come from properly designed studies, with random allocation to treatment condition and double-blind evaluation, the observations made in these cases cannot be conclusive.

For women with chronic psychiatric problems such as depression, bipolar disorder or psychotic disorders, it is important to weigh the risks and benefits of remaining on medication before making a decision.

Although there are potential risks involved with taking medication during a pregnancy, there are very real risks to both mother and child if important psychiatric medication is stopped.

For example, the recurrence of symptoms can lead to self-harming behaviour, which could be very dangerous to both mother and unborn child. Also, postpartum depression is much more likely to occur in women with a history of mental illness who are also not being treated. At the very least, if a woman with known risks decides to stop medication she needs to be carefully observed for the earliest signs of relapse.

Postpartum depression can have serious repercussions for the baby – ranging from death (in cases of infanticide) to lasting psychological damage from neglect or failure to bond at an early age.

Because of the fluctuating hormones and changes in body chemistry that are part of pregnancy, it is a particularly vulnerable time for women with a history of psychiatric illness. Women with existing illnesses are much more likely to relapse during pregnancy than when they are not pregnant.

In all cases, it is important to seriously consider all options and discuss risks with a physician.

Ask what is known about the drug in terms of its effect on fetal development. Learn the risks of both continuing treatment and stopping it. There is no easy way to make this decision. It is usually important to involve both the woman and her partner in such decisions.

While some psychiatric medications are known to cause problems in pregnancy, there are several that are thought to be quite safe. Your physician can help you access the most up-to-date information.

Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.


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