Psychiatric Medication Use in Pregnancy

Pregnancy-related medication decisions in psychiatry require shared decision making. Untreated depression or anxiety is associated with poor prenatal care, lower birth weight, and a higher risk of postpartum depression. Stopping a previously effective drug abruptly often leads to relapse, which itself harms pregnancy outcomes.

Most antidepressants are considered relatively safe during pregnancy. Sertraline and fluoxetine are commonly preferred. Paroxetine is generally avoided due to a small increase in cardiac malformations, and persistent pulmonary hypertension of the newborn is a recognized but rare association with late-pregnancy SSRI use. Mood stabilizers require more careful planning: valproate is contraindicated; lithium has been used safely with first-trimester monitoring; lamotrigine is often continued.

Postpartum care is as important as antenatal care. Most antidepressants are compatible with breastfeeding, with sertraline often first-line for new starts. Clozapine, lithium, and benzodiazepines require closer monitoring or discussion of alternatives. Postpartum depression and postpartum psychosis require urgent recognition and treatment.