Hands and feet

September 2009

Clinical

Motherhood and mental illness

Part 2 – management and medications

Volume 38, No.9, September 2009 Pages 688-692

Jacqueline Frayne

Thinh Nguyen

Suzanna Allen

Jonathan Rampono

Background

General practitioners see many women who may be on medication for the management of their mental illness before, during, or after a pregnancy.

Objective/s

This article reviews the current evidence and gives practical advice on management and use of psychotropic medication in women with mental health disorders in pregnancy.

Discussion

The general practitioner is often the first point of contact, and is vital in giving timely and accurate information and encouraging appropriate treatment choices in women with mental illness in our community. The risk-benefit analysis of treatment needs to be considered in light of the evidence at hand. Specialist opinion in complex cases must be sought early.

Choosing the right treatment for a pregnant or breastfeeding woman with a mood or anxiety disorder is a difficult task given the uncertainty surrounding the potential risks of medication. The common concern for many pregnant women is whether a medication will affect the development of their child, and in the absence of reassuring information, many will either forgo necessary pharmacotherapy or cease existing treatment, much to their own and that of their child’s detriment. While one cannot afford to minimise the unknown, the clinician needs to emphasise to their patient that the decision to use medication or any form of treatment during the pregnancy and breastfeeding period should occur after a thorough risk-benefit analysis with specific attention to the needs of the individual. The adverse effects of failure to treat may be significant for both mother and child.

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Correspondence afp@racgp.org.au

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