The ‘hidden’ and ‘forgotten’ psychiatry: The Perinatal Psychiatry

Author/s Laura Orsolini, Domenico De Berardis, Cesario Bellantuono
Publishing Year 2019 Issue 2019/1
Language English Pages 24 P. 35-58 File size 1895 KB
DOI 10.3280/RSF2019-001003
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In the last decade, there has been a growing amount of evidencebased publications in the field of "perinatal psychiatry", some focusing on the risk of an untreated psychiatric disorder for the mother and fetus or infant, others on the efficacy and safety of the available therapeutic treatments, including the psychopharmacology. Psychopathological conditions are the most common morbidities affecting women during pregnancy and postnatal period. Nowadays, it has been well documented that they may determine detrimental effects on the mother, the gestation and the fetus/infant. So far, no RCT are allowed, for ethical purposes, in the perinatal period, so that only a few well-designed prospective investigations and a few observational studies investigated the safety of psychotropic drugs during pregnancy and breastfeeding. Therefore, the ‘conventional’ clinical recommendation has been, in many cases, to discontinue them, especially during pregnancy, due to the risk of birth defects and neonatal adverse reactions. However, in the last decade, more evidence-based data, including original cohort studies, systematic reviews and meta-analyses, established that several psychotropic drugs can be considered relatively safe in early and late pregnancy as well as during breastfeeding and that not using them for psychiatric illness can be at greater risk for both mother and infant. An individualized and shared risk/benefit analysis is needed when judging use for a drug treatment in the perinatal period as evidence for the risks of such drugs is largely based on observational studies. An evidence-based updated short-review of general principles and recommendations to help clinicians in the use of psychotropic medications during the perinatal period are provided, according to the best recent international guidelines, overviews of the literature and expert opinions in the field of perinatal psychiatry and psychopharmacology.

Keywords: Perinatal period; psychopharmacology; perinatal psychiatry; pregnancy; breastfeeding; clinical recommendations.

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Laura Orsolini, Domenico De Berardis, Cesario Bellantuono, The ‘hidden’ and ‘forgotten’ psychiatry: The Perinatal Psychiatry in "RIVISTA SPERIMENTALE DI FRENIATRIA" 1/2019, pp 35-58, DOI: 10.3280/RSF2019-001003