Uso de eutimizantes durante el embarazo y la lactancia

A review is presented on the use of mood stabilisers and hypnotics during pregnancy and lactation, analysing their teratogenic effect, as well as the associated perinatal syndromes and the possible effects on the development of the newborn child. Recent evidence suggests that lamotrigine is the safest drug, despite it has only shown to be effective in the prevention of bipolar depression. It is demonstrated that lithium is clearly safer than that classically reported, whereas valproic acid must be avoided, and there is not sufficient experience with carbamazepine. The decision to treat or not to treat with a mood stabiliser will depend on a careful assessment of each patient. This should take into account her psychiatric history, as well as the association of bipolar disorder itself with obstetric complications. Unfavourable outcomes for the foetus, and the maximum risk of acute episodes linked to pregnancy, and especially the puerperium, must also be considered. Lithium seems to be less toxic than previously supposed for breastfeeding infants and lamotrigine can be also be used in selected cases. There appears to be no reasons to withdraw carbamazepine or valproic acid if the infant was exposed in pregnancy.