Managing mental health during pregnancy

Recent studies suggest a number of psychiatric medications are safe when you’re expecting

Tuesday, June 4 2019

Women who take medication to support their mental health have traditionally been advised to discontinue psychiatric medication during pregnancy. Newer studies are suggesting, however, that many such medications are safe for expectant mothers and their babies. Consequently, pregnant women and women who are trying to conceive, are encouraged to consult their treating psychiatrist about their options for managing mental health conditions.

“In the past it was believed that psychiatric medications were harmful to the unborn baby, however more recent studies have demonstrated that some kinds of psychiatric medication can often be continued in pregnancy with relative safety,” saysDr Lavinia Lumu, a specialist psychiatrist practising at Akeso Randburg – Crescent Clinic.
“Stopping psychiatric medication during pregnancy can actually result in more harm, not only to the mother but also to the baby. It is best for any woman who is taking psychiatric medication to consult their doctor to ensure that their medication is safe during pregnancy.”

“New research is starting to show that left untreated, depression and anxiety results in an excess production of cortisol, a stress hormone, in the mother. The excess cortisol is able to cross the placenta, which is supposed to act as a protective filtering mechanism for the unborn baby, and may affect the foetus by slowing down brain development and overall growth during pregnancy,” Dr Lumu explains.

“Foetuses exposed to high levels of cortisol are more likely to have difficulties after birth. There has been research that also suggests that babies who were exposed to untreated mental illnesses are at greater risk of developing mental illnesses themselves later in life.”

Dr Lumu says antidepressants are relatively safe to take during pregnancy, however it is imperative to consult an appropriate medical professional to establish any potential risks. Where there is any uncertainty about the safety of the specific medication, it is advisable to consult with both a specialist psychiatrist and the gynaecologist/obstetrician to establish the most appropriate course of action.

“There is a body of evidence to support the use of a specific class of antidepressants known as selective serotonin reuptake inhibitors [SSRIs] during pregnancy. Some research has indicated that some babies of mothers taking SSRIs during pregnancy may be born small for their gestational age, or develop neonatal abstinence syndrome or persistent pulmonary hypertension of the newborn.

“It should, however, be borne in mind that many of the patients in the studies had other clinical factors that could have also have had an influence, which makes it difficult to attribute these risks to antidepressants alone.

“The potential risks of taking most kinds of antidepressants during pregnancy are relatively low, but should only be done, if required, after having consulted with a psychiatrist and gynaecologist/obstetrician.”

According to Dr Lumu, a specialist psychiatrist should assess the patient to reach a determination on the use of antidepressants in pregnancy. The severity of the depression needs to be determined, and the risks of not taking medication must be weighed against the benefits of taking medication.

“In some instances, mild to moderate depression can be managed without medication through psychotherapy with a psychologist, but it is always best to consult a psychiatrist,” she adds.

There are many classes of medication to treat different mental health conditions. The most common classes of medication used in pregnancy are:

  • Antidepressants: SSRIs (Selective serotonin-re-uptake-inhibitors) are the safest class and have been the most researched. Examples include fluoxetine, sertraline, escitalopram and citalopram. Paroxetine, however, is not safe for use in pregnancy.
  • Mood-stabilisers: Examples include lamotrigine and lithium. It should be noted that there is a 1:1000 chance of Epstein’s anomaly in lithium-exposed infants. Sodium valproate is not safe in pregnancy.
  • Antipsychotics: Examples include haloperidol, risperidone, olanzapine, and quetiapine. Most antipsychotics are relatively safe in pregnancy and are often used for their mood-stabilising properties in the treatment of bipolar disorder.
  • Eglonyl (sulpiride) is an older antipsychotic drug commonly prescribed by obstetricians/gynaecologists or other doctors for the treatment of postnatal depression and also for the stimulation of lactation. Despite its frequent use, it is not an antidepressant and therefore has poor efficacy in the treatment of depressive symptoms.
  • It is important to note that benzodiazepines, ‘tranquilisers’ and ‘sedatives’ are not safe for use in pregnancy.

“If you find out that you are pregnant while taking antidepressants, it is recommended that you consult your specialist psychiatrist to determine whether you should continue with your medication, and also speak to your obstetrician/gynaecologist. Your doctor may change your prescribed treatment to another medication that is safer for you and your baby, or modify the dosage of the medicine you are currently prescribed,” she advises.

“One should never stop medication unless instructed to do so by an appropriate medical professional,” Dr Lumu concludes.

Ends

* References for this article are available on request.

About the Akeso Group
Akeso is a group of private in-patient psychiatric hospitals, and is part of the Netcare Group. Akeso provides individual, integrated and family-oriented treatment in specialised in-patient treatment facilities, for a range of psychiatric, psychological and addictive conditions.

Please visit www.akeso.co.za, email info@akeso.co.za, or contact Akeso on 011 301 0369 or Akeso Randburg – Crescent Clinic on 087 098 0457 for further information. In the event of a psychological crisis, please call 0861 435 787 for assistance.

Issued by:           MNA on behalf of Akeso Randburg – Crescent Clinic
Contact:               Martina Nicholson, Graeme Swinney, Meggan Saville or Estene Lotriet-Vorster
Telephone:        (011) 469 3016
Email:                   martina@mnapr.co.za, graeme@mnapr.co.za, meggan@mnapr.co.za or estene@mnapr.co.za