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Antipsychotics and pregnancy: what you should know



Choosing a baby (or another) is a big step for everyone. However, taking antipsychotics for a mental health problem such as bipolar disorder or schizophrenia may raise additional questions: Can your medication affect your fertility? Is it safe to take these medicines during your pregnancy ? Is it safe to stop to take it? The answers are not always clear, so it is important to talk to your doctor. Here is a primer that can provide some insights before your appointment.

Let us summarize why antipsychotics are sometimes used to treat conditions such as bipolar disorder and schizophrenia.

Psychosis is a state in which one stands out from reality. According to the National Institute of Mental Health (19459015) (NIMH), this can lead to delusions (misconceptions) and hallucinations (seeing and hearing things that are not there).

This can happen with certain mental health conditions such as schizophrenia and bipolar disorder. According to Mayo Clinic (19459018), schizophrenia can often cause difficulties in interpreting reality. In addition to delusions and hallucinations, it can lead to extremely messy speech and behavior as well as to so-called negative symptoms or dysfunctions (such as maintaining personal hygiene or social commitment).

Bipolar disorder on the other hand, is a condition characterized by mood episodes that can take various forms. Someone may experience a manic episode if they have at least seven days of extremely elevated mood and energy levels, according to NIMH . (Or shorter than that if the symptoms are so severe that hospitalization is required.) Someone might have a hypomanic episode if he has an elevated mood and energy for at least [4] days but on a less extreme level than a manic episode. Someone experiencing a depressive episode has a sense of sadness and hopelessness along with lowered energy levels for at least two weeks. And someone who experiences a mixed mood episode would also have persistent symptoms of mania and depression. When a person's depressive or manic mood becomes severe, this can lead to psychosis .

Antipsychotics should help to solve the reality of diseases that can cause diseases such as schizophrenia and bipolar disorder. These drugs usually work until and affect the levels of neurotransmitters in the brain that affect mood, such as dopamine and serotonin, says Jamie Alan, Ph.D., a professor of pharmacology and toxicology Michigan State University, opposite SELF. 19659009] Antipsychotics can be divided into two groups: typical (first generation) and atypical (second generation). Both can treat schizophrenia and bipolar mania, but only atypical antipsychotics can be used to treat bipolar depression, says NIMH .

Studies show that antipsychotics can complicate the conception.

This is because their action on the neurotransmitter dopamine may have the potential to increase levels of the hormone prolactin in the body, which may lead to anovulation of in some people. If this is the case with you, your body may not release eggs for possible fertilization. Alan. "The prolactin levels of [changes in]however, vary with dose, and it's difficult to predict which change in prolactin will affect an individual's fertility," she says.

Translation: Taking antipsychotics or increasing prolactin levels does not automatically mean that you will have difficulty understanding. In addition, much of the research on the effects of bipolar disorder by drugs has been conducted on rodent (not human) rodent fertility. This possible compound has not been studied with all antipsychotics. Different antipsychotics may affect your dopamine levels to varying degrees. 19659013] Even with these reservations, we know that sounds daunting. However, it is quite possible to take part in these medications and have no associated problems with conception, explains Jonathan Schaffir, a doctor at Ohio State University's Wexner Medical Center, opposite to the SELF. In addition, finding the right mix of bipolar disorder or schizophrenia medication may be necessary to be in the healthiest condition before conception. If you are taking antipsychotics and are worried about how they might affect your prolactin levels and your fertility, ask your doctor what you should know.

If antipsychotics are taken during pregnancy, experts suggest you discuss your specific case with your provider.

Although doctors have a somewhat decent idea of ​​how different psychiatric treatments can affect pregnancy, many of these drugs have not been widely studied in humans, as many pregnant women generally do not want to enroll in this type of research, Dr. Schaffir. This means that a lot is uncertain when it comes to how antipsychotics are due to birth defects. The general medical consensus is that this is an important and nuanced issue that needs much further investigation, as many of the results have so far been inconsistent.

Several studies have shown that antipsychotics can actually contribute to birth defects [13]. NIMH . (Especially in the first trimester, when many important organs and structures form .) However, much of this research was small or was done on animals, and there are so many possible confounders that need to be fixed Draw conclusion. Ultimately, it is difficult to find out how powerful antipsychotics can be in terms of congenital defects.

In addition, most of the relevant antipsychotic / gestational research was conducted on the typical antipsychotic haloperidol, which did not conclude birth defects, says NIMH . However, the researchers are still investigating how other antipsychotics could affect pregnancy.

To this end, a 2016 study of 1.3 million pregnant women published in JAMA Psychiatry found that there was no significantly increased risk for congenital infants associated with arbitrary [19659024] Type of use of antipsychotics in the first trimester. The only possible exception was the atypical antipsychotic risperidone in which the authors of the study found a low increased risk. However, the authors of the study point out that this conclusion should be interpreted with caution, since they could not prove causality and this could have been a coincidental finding. Rather than confirming that risperidone is associated with birth defects, the authors of the study find that this simply justifies further investigation.

As the authors of the study noted in an overview of Obstetrics and Gynecological Study of 2016, everyone's risk of birth defects in antipsychotics may be less directly associated with the drugs than with an indirect risk related to their side effects. Some antipsychotics are associated with metabolic side effects of such as weight gain and elevated glucose levels, which may then increase the risk of problems such as neural tube defects [1969].

Apart from the question of using antipsychotics in the first trimester, there is also the concern that antipsychotics taken in combination with other medicines may increase the risk of birth defects (NIMH ). For example, many people with bipolar disorder take multiple medications including mood stabilizers such as lithium, which, unlike antipsychotics, have a known potential to cause birth defects The possible link here is far from to be final. The US Antipsychotics Authorities (FDA) generally do not state that they should not be used during pregnancy. There is no clear, evidence-based reason to believe that the use of an antipsychotic during pregnancy is more likely to lead to birth defects. Instead, the FDA labels for antipsychotics state that they should be reserved for cases where the potential benefit outweighs the potential risks. Even with the mood stabilizer lithium, which is more significantly associated with birth defects, its FDA label advises the prescribing physician to weigh this possibility in the event of pregnancy, along with its monitoring and dosage, if it continues to be used the drug during pregnancy – it does not mean that pregnant people can not use the drug.

The FDA warns that there is a link between third-trimester antipsychotics and neonatal problems.

is still unclear when it comes to antipsychotics and pregnancy: in 2011, the FDA issued a safety notice on the subject.

The FDA stated that the "pregnancy" sections have been updated. All antipsychotics should contain more information on how the use of antipsychotics in the third trimester of pregnancy can affect newborns.

According to the FDA there is a potential risk of abnormal muscle movement (t This is known as extrapyramidal signs (EPS) and withdrawal in these newborns.) Symptoms include agitation, hypertension (too much muscle tone leading to stiffness), hypotension (too little muscle tone leading to flaccidity), tremors, drowsiness and more.Many of these symptoms are known antipsychotic side effects and it is clear according to FDA in newborns, these symptoms may disappear in a few days without treatment or require hospitalization.

Despite this possibility, it is incredibly important for anyone taking antipsychotics – pregnant or not – the use of this medication does not stop without first talking to your doctor medical consensus not that all antipsychotics are contraindicated during pregnancy. It is sometimes the case that the benefits of taking antipsychotics during pregnancy outweigh the risks and vice versa. That must be the deciding factor.

For some people, it still makes sense to take antipsychotics during pregnancy or during pregnancy. You can only know where you fell when talking to your doctor.

"It is important to know that we have no detailed explanation of how the risks of these drugs are weighed against the risks of the disease itself. Schaffir says.

For example, if you are not treated with medication, if you have bipolar disorder, you increase your chances of experiencing risky, life-threatening behavior during manic episodes and suicidal thoughts during depression or mixed mood. The risks of taking certain medications "must be reconciled with the risks of untreated mania or depression, which can be considerable," he says. The same applies to schizophrenia.

If you are taking antipsychotics and want to get pregnant, it is a good idea to have a conversation with your ob / gyn and psychiatrist first.

If you're ready to give it a try Your doctor may recommend that you change your medication to something less risky of your future pregnancy during this time, Dr. Synthase.

As soon as you become pregnant, it is important to have an open dialogue with your doctor about how your medications are working and if there are concerns that they will be transmitted to your baby through breastfeeding. "You really want to start these discussions before conception so you can make a plan," says Dr. Schaffir.

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