Co-Director Kathryn Emerick, MD
photo: Jamie Manser
Staying informed about perinatal mental health research is essential when working with this population. Providing appropriate treatment includes having a background understanding of psychiatric assessment, diagnosis, and treatment options. It also requires both specialized training in assessment of perinatal individuals and an understanding of the current research on psychotropic medications in pregnancy. It can be difficult to stay abreast of the evolving data regarding psychotropic medications in pregnancy because it is quickly progressing. The increased interest in this area has led to an increased understanding of risks associated with psychotropic medications, but at times also leaves us with more questions. One such example is the history of research into selective serotonin reuptake inhibitors (SSRIs), which have been thought to increase the risk of preterm birth. The actual data is more complicated – there have been studies supporting the increased risks of preterm birth with SSRIs and studies that have found no association. Understanding the discrepancy in the research into SSRIs highlights the need as perinatal mental health professionals to critically evaluate data and to keep in mind the entire breadth of the available research. One way to do this is by utilizing the GRAVE method, an acronym for Generalizability, Reliability, Alternatives, Validity, and Ethics. For the SSRI conundrum, we can consider questions such as:
- Was the sample size very small, or was it from a huge registry where it is difficult to clearly characterize all the participants?
- Did the patients who took SSRIs have remission of symptoms or were they still depressed?
- Were they on any other medications that could contribute to the outcome?
- When during pregnancy was the exposure?
- Did they have other psychiatric illness?
- Did they have any other medical contributors?
It can be difficult to keep up with the data and identifying reliable, frequently updated sources for summaries can be helpful. Some that may be useful for your practice include:
- Reprotox – summarizes known data for medication in pregnancy.
- LactMed – summarizes known data for medication in breastfeeding.
- MGH Center for Women’s Mental Health – provides medication and research updates.
