SYMPOSIA

Bulletin of Clinical Psychopharmacology, Vol: 21, Supplement: 2, 2011 - www.psikofarmakoloji.org
Abstracts of the Invited Speakers
because both effective pharmacological agents and untreated maternal anxiety seem to be associated with several negative outcomes
on the course of pregnancy and the fetus. Despite the absence of practical guidelines for pharmacological management of panic disorder
during pregnancy and lactation, some general points about pharmacological treatment include the following: (1) Pharmacotherapy
should be preferred when the potential impact of untreated maternal panic disorder is higher than the impact of the pharmacological
agent on the fetus or new mother. (2) The patient and relatives should be informed about the benefits and risks of pharmacological
treatment or nontreatment of the current maternal psychiatric picture and written informed consent forms should be obtained. (3)
Selective serotonin reuptake inhibitors except paroxetine and low dose imipramine may be preferred during pregnancy. (4) Sertraline,
paroxetine, orlow doses of imipramine or clomipramine appear to be appropriate pharmacological agents during the lactation period.
Key words: Panic disorder, pregnancy, lactation
Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S70-1
Psychotropic drug treatment during pregnancy and lactation in obsessive compulsive disorder
Servet Ebrinç
GATA Haydarpasa Training Hospital, Clinic of Psychiatry, Istanbul, Turkey
E-mail: sebrinc1@gmail.com
According to recent studies, obsessive compulsive disorder(OCD) is one of the leading cause of disability and the prevalence of OCD is
found to be 0.2-3.5% in pregnancy and 2.7-9% in the postpartum period.
The efficacy and tolerability of SSRIs and SNRIs in the treatment of OCD are well-determined in many double-blind randomized controlled
trials. Despite the fact that it is well known that OCD patients may benefit from antiobsessional therapy during pregnancy and the
postpartum period, very little data are available about the efficacy of the treatment and no evidence suggests that patients would react
differently to these drugs. Hence, OCD women who are pregnant and in the postpartum period might be treated using standardized
treatment approaches.
During pregnancy and the postpartum period, the treatment of OCD should clinically take the risks and benefits of several treatment
modalities and the expectations of the patient into account. While cognitive-behavioral therapy (CBT) is the leading choice in nonpharmacological
treatment of OCD, pharmacoterapy might be used if necessary.
If CBT is inadequate and pharmacotherapy is needed, during pregnancy, fluoxetine, and during the lactation period, paroxetine, are
proposed to be the first line treatments. Although evidence is limited, other SSRIs are acceptable as alternative treatment options.
All of the antidepressant drugs are transferred to the nursing infant during breastfeeding. The American Academy of Pediatrics classifies
psychotropic drugs as “drugs whose effects are unknown, but may be of concern.” The best way of determining the exposure to the drug is
measuring the drug concentration in the plasma of the baby. Clinical evaluation is important to identify any side effects while monitoring the baby.
There is no evidence indicating an increase in the rates of intrauterine death or malformation in the case of exposure to tricyclics or
SSRIs. Whether exposure to SSRIs causes a decrease in birth weight or an increase in premature births is not certain and the evidence is
controversial. Nonetheless, The Food and Drug Administration (FDA) has determined that first trimester exposure to paroxetine might
cause an increase in the risk for congenital malformations particularly cardiac defects. Therefore, the FDA has changed paroxetine’s
pregnancy category from C (risk can not be ruled out) to D (positive evidence of human fetal risk).
A “withdrawal syndrome,” consisting of symptoms in the locomotor, central nervous, respiratory and gastrointestinal systems may occur
in newborns exposed to SSRIs in the third trimester. Although monitoring is required in an exposed newborn, this syndrome is relatively
mild, can be managed with supportive therapy and diminishes within 2 weeks. Some evidence points out an increase in the rates of
persistent pulmonary hypertension in infants exposed to SSRIs during the third trimester. Before delivery, lowering the dosage of the
mother’s drugs that might have been augmented due to the symptom severity of OCD, is recommended.
Key words: lactation, obsessive-compulsive disorder (OCD), psychopharmacotherapy, pregnancy
References:
1. Clinical Management Guidelines for Obstetrician-Gynecologists Use of Psychiatric Medications During Pregnancy and Lactation. ACOG Practice Bulletin,
(Reprinted with permission from Obstetrics & Gynecology 2008; 111:1001–1020)
2. Brandes M, Soares CN, Cohen LS. Postpartum onset obsessive-compulsive disorder: diagnosis and management. Arch Womens Ment Health 2004; 7:99–110
3. Use of Psychoactive Medication During Pregnancy and Possible Effects on the Fetus and Newborn Amerikan Academy of Pediatrics Committee on Drugs Pediatrics
2000; 105; 880-887
4. Koran LM, Hanna GL, Hollander E et al. Practice Guidline for theTreatment of Patients with Obsessive-Compulsive Disorder. Copyright 2010, American Psychiatric
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