Treatment of Mental Disorders in Pregnancy: A Review of Neuroleptics, Antidepressants, and Lithium Carbonate

Pregnancy is frequently complicated by the development or recurrence of a serious mental disorder; neurotic, major affective, and psychotic illnesses have all been observed (1-4). When a major mental disorder arises in a pregnant woman and threatens the health or life of the patient and/or fetus, it should be treated early and aggressively to minimize complications and forestall the advance of the disease. Nonbiologic methods like individual psychotherapy, couples or family therapy, social casework, and hospitalization in a supportive, structured milieu should form the first line of treatment. Electroconvulsive therapy (ECT) may be the treatment of choice for some patients, e.g., a first trimester mother with a life-threatening episode of bipolar illness. If the illness persists in spite of nonbiological interventions, and if the risks of the inadequately treated disease outweigh the risks associated with a potentially useful medication, then a trial of that medication is clearly indicated