Psychiatrists’ attitudes toward psychopharmacologic treatments during pregnancy and lactation periods: a survey study
Objective: Pregnancy and lactation are risk periods when women are susceptible to psychiatric illnesses. As well as side effects and teratogenic effects of drug utilization, negative effects of untreated psychiatric illnesses on the fetus and mother may be issues of concern. Management of pregnancy and lactation periods may become complicated by a relapse of a psychiatric illness or by using a drug with unexpected harm effecting mother or baby. Mental health professionals are commonly confronted with patients who ask for advice during such times. In determining the course of treatment, the attitudes of mental health professionals are as important as the attitudes of patients. This study was conducted to evaluate attitudes and personal opinions of psychiatrists.
Methods: An Internet survey was designed to ask questions about the tendency to use pharmacotherapy, electroconvulsive therapy (ECT), or psychotherapy, or to stop or lower the dosage of medicines, and the personal principles of psychiatrists during pregnancy and lactation. The relationship between academic degrees and professed knowledge levels of psychiatrists about management of treatments of pregnant and lactating women and personal comments were also evaluated. Of those asked, 246 psychiatrists replied and 213 online-surveys were completed.
Results: Of the respondents, 22.2% were psychiatry residents, 50.9% were attending psychiatrists, 6.6% were assistant professors, 9% were associate professors, and 11.3% were full professors. The results showed that avoidance of starting drug therapy, terminating an ongoing drug treatment, seeking alternatives to drug treatment, transitioning to ECT treatment and consulting a higher center were significantly more common in pregnancy than during the lactation period (p<0.05). Low, dosage-safe medicine use was preferred in both periods. In cases where drug utilization was deemed necessary, higher scores were obtained regarding the opinion that it was necessary to ‘avoid pregnancy’ than to ‘avoid lactation’. The attitudes of psychiatrists did not change according to the level of their knowledge that they professed. Of psychiatrists, 85% stated that they know and successfully apply drug utilization principles in pregnancy and lactation (always and generally), and 81% stated that during examination, they were able to provide their patients needed information and training. Psychiatrists did not prefer to terminate a pregnancy if medicine was needed for treatment with a response rate of 61.1% for ‘never’.
Conclusions: The present study showed that the psychiatrists were reluctant in prescribing psychotropic drugs during pregnancy, but they were more comfortable doing so in the lactation period. The attitudes of the psychiatrists seemed independent from their generally stated knowledge levels. The present study is valuable because it shows the differences in attitudes of the psychiatrists regarding their treatment approaches in the periods of pregnancy and lactation. More understandable messages from the leading researchers in this area and guidelines are needed for outlining clearer principles.