Today on the podcast we pick the brain of Dr Matthew Coates, a psychiatrist with experience in perinatal mental health. We talk about the common dilemmas of antidepressant prescribing in pregnancy and how to pick the post-natal patient with genuine mental illness as well as breastfeeding and neonatal issues. We also take a look at the more serious end of the spectrum of psychosis and mania in pregnancy and the post-partum period.
Take home messages:
- Pre-conception planning is important for patients on psychotropic medications.
- The ideal choice of antidepressants in pregnancy is the one that works for the patient. SSRIs have been better studied than SNRIs. Dosages may need to be increased in the third trimester.
- Use non-drug strategies such as psychological therapies.
- Patients with bipolar 1 and psychosis should be jointly managed with a psychiatrist.
- Consider the effects of psychotropic medications on the neonate when planning for delivery.
- Post-partum psychosis is a psychiatric emergency. Engage perinatal psychiatric services urgently.
References & Resources
Massachuset’s General Hospital Center for Women’s Mental Health – womensmentalhealth.org
Perinatal Psychotropic Medications Information Service – ppmis.org.au
Drugs and lactation database – LactMed
Bergink et al, American Journal Of Psychiatry 2012 – Prevention of postpartum psychosis and mania in women at high risk