Pharmacologic Management of Reproductive Psychopathology

The pharmacological management of psychopathology among women, specifically during their reproductive years, is highly complex and requires specialized knowledge regarding medication efficacy and safety. In this chapter, the reader is introduced to the complex guidelines for treating women in the peripartum period with psychotropic medicines, elaborating on common mental disorders including depression, bipolar illness, anxiety, posttraumatic stress and other trauma-related conditions, ADHD, and substance use disorders. It is highlighted that mental illness during the peripartum, that is, pregnancy and the first year after the infant’s birth, is highly prevalent. While the pharmacological management of mental health conditions during the peripartum is often comparable to treating such conditions at any other period in a woman’s life, decisions regarding medication selection require not only consideration of side effects for the mother but must also consider potential adverse effects on the pregnancy, the fetus, delivery, and long-term child development. Thus, critical to reproductive psychiatry is a personalized risk-benefit analysis accounting for a broad range of considerations. In this text the aim is to provide the reader with the foundational knowledge needed to support the patient and family in this complex decision-making process. Treatment algorithms for the pharmacologic management of premenstrual and perimenopausal mental health disorders are also presented. The overall goal of this chapter is to offer comprehensive, yet user-friendly, state-of-the-art information on medication management in reproductive psychiatry.