Treating recurrent affective disorders during and after pregnancy. What can be taken safely?

Since pregnancy and the time thereafter is a precarious period for women with recurrent affective disorders and their offspring, it is important to determine the risk of various treatments for such disorders. This review assesses the risk to the fetus, the perinatal risks for mother and infant, the risks associated with treatment during the puerperium and breastfeeding, and the risks to the later development of the child. This review considers treatment with lithium, tricyclic antidepressants (TCAs), selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRIs), monoamine oxidase inhibitors, other antidepressants, and the anticonvulsants carbamazepine and valproic acid (sodium valproate). According to available evidence, use of lithium, TCAs and SSRIs is justified during and after pregnancy if treatment is required; no prophylactic treatment has a lower risk: benefit ratio. The review provides guidelines for the use of these drugs.