Despite the use of the newer “atypical” antipsychotic agents to treat a spectrum of psychiatric disorders, including schizophrenia, bipolar disorder, major depression, PTSD and other anxiety disorders, three is relatively little data on the reproductive safety of these newer atypical agents.
Since their introduction in the 1990s, atypical (second-generation) antipsychotics have replaced typical (first generation) antipsychotics as the first-line treatment for schizophrenia and related psychotic disorders. These drugs are widely used by reproductive age women across many other disease states including bipolar disorder, major depression and anxiety disorders as either primary or adjunctive treatments.
Atypical antipsychotic medications are commonly used for the treatment of schizophrenia and bipolar disorder. Despite the increasing use of these medications in women of child-bearing age, there is still relatively little data regarding the reproductive safety and long-term neurodevelopmental effects of these medications. A recent study assessed the development of 76 infants with fetal exposure to atypical antipsychotics.
Atypical antipsychotic medications are commonly used for the treatment of schizophrenia and bipolar disorder. Despite the increasing use of these medications in women of child-bearing age, there is still relatively little data regarding the reproductive safety of these medications.
Menstrual irregularity is a common side effect of antipsychotic treatment in women, occurring more commonly in those treated with risperidone and the older antipsychotic medications. New research presented at the APA earlier this month indicated that the addition of metformin at 500 mg bid resolved menstrual irregularities in most women treated with antipsychotic medications. (Metformin is a medication used alone or with other medications, including insulin, to treat type 2 diabetes.) In addition, women receiving metformin lost an average 2.4 kg of weight after 6 months of treatment.
While a handful of studies have assessed the risk for congenital malformations in infants exposed to antipsychotic agents, there is even less information regarding neonatal outcome in this population. In 1992, it was first reported that infants exposed to first-generation antipsychotic medications exhibited increased muscle tone, tremulousness, and poor motor functioning when assessed within a few days of delivery.
We want to thank those of you who have continued to subscribe to our blog and who have visited our website. Some have written noting particular interest in the research conducted at the MGH Center for Women's Mental Health, including the National Pregnancy Registry for Atypical Antipsychotics.
May 2011, ObGyn News, Lee S. Cohen, MD
Women face difficult choices when deciding whether or not to continue psychiatric medications during pregnancy. This choice can be especially difficult for women taking newer medications which lack adequate reproductive safety data.
On February 22, 2011, the U.S. Food and Drug Administration (FDA) informed healthcare professionals that drug labels for the entire class of antipsychotic drugs have been updated to include warnings regarding the use of antipsychotic drugs during pregnancy. The new drug labels now contain more details on the potential risk for abnormal muscle movements (extrapyramidal signs or EPS) and withdrawal symptoms in newborns exposed to these drugs during the third trimester of pregnancy.
