Psychiatric Disease and Medications in

Pregnancy and Post-Partum Period

Are there any category A psychotropics? - ANS no

what is the single, most influencing factor for consideration of going on meds before pregnancy?
- ANS severity of the depression

what is the risk of relapse of depression after discontinuing psych meds? - ANS 67-80%

zolpidem has what kind of pregnancy category rating? - ANS category C

do gravid rates of depression = non-gravid rates of depression? - ANS yes

what are the overlapping symptoms that occur in depression and in pregnancy? - ANS
disturbance of sleep, disturbance of appetite, fatigue, libido, tearfulness, anxiety

what is the worst SSRI to give a pregnant woman? - ANS paroxetine

is there an associated increased risk of miscarriage with the usage of antidepressants? - ANS
yes

are TCAs and SSRIs relatively safe to give to pregnant women? - ANS yes

what kind of fetal birth defects are believed to be associated with the usage of antidepressants?
- ANS septal defects (cardiac malformations)

maternal use of SSRIs after the 20th week of pregnancy was associated with an increased risk
for what in the infant? - ANS primary pulmonary hypertension (paroxitine = biggest culprit); risk
seems to be higher when the SSRI is administered late in pregnancy

what kind of risk for preterm birth and NICU admissions with the usage of SSRIs? - ANS
increased risk for both

gestational age changed how with exposure to SSRIs? - ANS gestational age at birth was
lower

any change in APGAR scores or weight with SSRI usage? - ANS no

withdrawal syndrome was seen in infants with mothers who took SSRIs when? - ANS late
pregnancy

what are the symptoms of withdrawal symptoms in infants exposed to SSRIs? - ANS
jitteriness, tachypnea, irritability, tremulousness, tachycardia, respiratory difficulty

withdrawal symptoms in infant to SSRIs tends to be transient or permanent? - ANS transient

any risk of long-term changes in the child with exposure to SSRIs during pregnancy? - ANS no

maternal depression puts the mother at an increased risk for which medical conditions? - ANS
preeclampsia, low birth weight in child, increased risk for c-section, decreased pain tolerance
and epidural use, increase in NICU admissions, behavioral problems in 3-4 year olds, increased
risk of postpartum depression

what must you remember with tapering SNRIs? - ANS must do it very slowly (have very
serious withdrawal symptoms)

what are the best SSRIs to use for pregnant women? - ANS escitalopram, citalopram,
fluoxetine

can ECT be used for pregnant women? - ANS yes - can be used for severely depressed,
psychotic or suicidal patient

there is a higher risk of bipolar symptom exacerbation when? - ANS post-partum

risk of relapse with bipolar disorder is high or low? - ANS high

lithium is believed to cause what kind of defect in the fetus? - ANS ebstein's anomaly (problem
with tricuspid valve)

valproic acid use in pregnancy is associated with what defect in the fetus? - ANS NTDs

carbamazepine use during pregnancy has a high rate of what defect in the fetus? - ANS cleft
palate

least amount of fetal defects with the usage of what anticonvulsant? - ANS lamotrigine

overall, what are anticonvulsants associated with regarding the fetus when used during
pregnancy? - ANS prematurity, low birth weight, low APGAR, decreased head circumference

any risk of fetal malformation with the usage of risperidone? - ANS no

is there a higher risk of NICU admissions post birth with the usage of antipsychotics? - ANS
yes

do psychiatrists suggest continuing antipsychotics in women during pregnancy? - ANS yes the
suggest continuing them

if a pregnant woman has schizophrenia, is their pregnancy considered a high risk pregnancy? -
ANS yes - less prenatal care, poorer nutrition, alcohol, tobacco, illicit drug usage

what kinds of effects do you see in the infant born to mothers with schizophrena? - ANS lower
APGAR scores, low birth weight, IUGR, preterm delivery, stillbirth, congenital malformations,
infant death

which are better for pregnancy, typical or atypical antipsychotics? - ANS atypical antipsychotics

what percentage of women experience some degree of mood disturbance after delivery? - ANS
85%

what percentage of women experience significant mood disturbance after delivery? - ANS
10-15%

postpartum blues is common in what percentage of women following delivery? - ANS 50-85%

what are the symptoms associated with postpartum blues? - ANS reactive mood, tearfulness,
irritability

postpartum blues are limited to what time period after delivery? - ANS first 1-2 weeks

postpartum depression affects what percentage of women after delivery? - ANS 10-15%

when does postpartum depression usually appear after pregnancy? - ANS 2-3 months after
delivery

what are the symptoms associated with postpartum depression? - ANS depressed mood,
anhedonia, irritability, insomnia, fatigue, loss of appetite, anxiety and rumination

what kinds of effects could the newborn experience from postpartum depression in mother? -
ANS social engagement issues, self-regulation issues, irritability, increased physiological stress
response

what is the treatment of choice for women with post-partum depression? - ANS SSRIs, also
could use benzodiazepines, estrogen/progesterone

is postpartum psychosis an emergency? - ANS yes (hospitalization may be necessary)

if depression is severe in postpartum psychosis, what kind of treatment should be used? - ANS
ECT

what is the go-to treatment for postpartum psychosis? - ANS antipsychotic

if there is a history of post-partum psychosis or bipolar disorder, what can you do

prophylactically? - ANS consider prophylactic treatment with lithium (can initiate at 36 weeks or
begin within 48 hours following delivery)

is all psychotropic medication found in breast milk? - ANS yes

peak concentrations of psychotropic meds are when after taking them? - ANS 6-8 hours

which medications would be suggested for use in a breastfeeding mother (psychotropics)? -

ANS sertraline, escitalopram, citalopram

what is the risk of using benzos in breastfeeding women? - ANS sedation, poor feeding,
respiratory distress

is lithium excreted in breast milk? - ANS yes, in very high doses (check TSH, BUN, and
creatinine)

what is the concern with the use of carbemazepine in the breastfeeding mother? - ANS
hepatotoxicity, hepatic dysfunction

what is the concern with the use of lamotrigine in breastfeeding mothers? - ANS
steven-johnson syndrome

what is the concern regarding valproic acid use in breastfeeding mother? - ANS hepatic
toxicity, must monitor infant serum LFTs, platelets

avoid benzodiazepine usage in breastfeeding women until when? - ANS until cessation of
nursing