This week, in our column where we discuss issues related to women, I will talk about an issue that concerns all expecting parents, especially women, about how to apply psychiatric treatment and medication during pregnancy.
Pregnancy and birth are the most special moments in a woman's life. Although it is one of those moments, it is also a developmental crisis process. During pregnancy, in addition to physiological changes, psychological and social changes also occur. During pregnancy, which is a dynamic process, hormonal changes can cause unusual mood swings and physical discomfort. A woman's reaction to pregnancy is closely related to her early childhood experiences, coping methods, personality traits, position in life, psychosocial support and the presence of physical problems. Considering these variables, it is not surprising that the stress of pregnancy and birth increases susceptibility to psychiatric diseases for some women.
So what worries both physicians and people expecting a baby about conditions that require treatment? What makes treating a pregnant woman different from treating a non-pregnant woman? As a physician, our main goal is to provide safe and effective treatment for our patient. However, when it comes to a mother expecting a baby, there are two individuals whose health should be taken into consideration. Almost every problem that affects the mother has the possibility of affecting the fetus. Likewise, almost any treatment applied to the mother will have a direct effect on the fetus. In other words, a psychiatric condition during pregnancy may negatively affect the fetus, but any treatment applied may also have a negative effect on the fetus. When the situation is viewed in this way, the situation seems unsolvable and the woman who is pregnant and has mental problems seems helpless. The situation becomes even more complicated, especially with hearsay information. If you want, let's try to look at the situation from a different and correct perspective.
It is known that anxiety symptoms, depression and emotional fluctuations are common during pregnancy, as well as substance addiction, eating disorders, mood disorders and psychotic disorders in female patients of reproductive age. disorders may be observed. Need for psychiatric treatment during pregnancy We can examine it under three headings.
Patients whose psychiatric illness started during pregnancy; The common opinion of most psychiatrists on this issue is that psychiatric symptoms during pregnancy should be treated with non-drug interventions as much as possible. But there is no single prescription for everyone. Instead, a careful and prudent evaluation is required, taking into account each patient's individual needs and unique situation. A path should be drawn about what the necessary treatment will be (medication use, ECT, TMS, psychotherapy applications), and the pros and cons of this path should be discussed in detail with the person. chronic psychiatric patients who want First of all, the patient should be informed about the situations that will arise before pregnancy and an action plan should be made when she is healthy. The psychiatrist should discuss the impact of pregnancy on treatment preferences with the patient and convey risk-benefit information about the mother and the fetus. In fact, no psychiatric medication is unconditionally approved for use during pregnancy. However, since studies have reported high relapse rates following drug discontinuation in many patients, discontinuing psychiatric drug treatment in those with chronic psychiatric diseases during pregnancy is a serious decision.
Psychiatric medication due to any mental problem. Patients who became pregnant unknowingly while using it; The patient's diagnosis and the possible effects of the medication he/she uses on the fetus should be reviewed, and he/she should be referred to a gynecologist and obstetrician for the necessary examinations. An arrangement should be made by reviewing whether the current treatment can be continued and what other treatment options can be chosen instead of medication.
The following items should be questioned in order to evaluate the risks that may occur during pregnancy and to make a decision on drug use.
Specific psychiatric symptoms or the course of the disease during pregnancy,
Past history of psychiatric illness,
Previous medication-free the course of the disease in different periods,
Before and before non-drug treatments Answer given,
Level of relationship with social support systems and family,
Own thoughts about continuing the pregnancy,
Abortion and miscarriage history,
Severity of symptoms or disease,
Stage of pregnancy ,
Patient's preferences.
Non-drug treatment options should be reviewed during pregnancy, and patients who are determined to use psychiatric medication should not be asked to take medication for themselves and their spouses. Side effects, risks of not using the medication, side effects of the medication, withdrawal symptoms that may occur if discontinued, and structural and behavioral effects of the medication on the fetus should be explained. Information should also be given about all other treatment options that can replace drug therapy. If it is decided to use psychiatric medication, it is necessary to use a single medication and the lowest effective dose of this medication whenever possible, to call for more frequent check-ups in cooperation with gynecology specialists, and if necessary, laboratory methods such as drug blood levels, ECG, ultrasound, fetal ECG should be used more frequently.
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