Are Psychotropic Drugs Safe to Use During Pregnancy?

Most psychotropics are currently given a US Food and Drug Adminstration (FDA) drug rating of category C, meaning there is evidence of potential risk to a fetus. Some psychotropics, however, have a higher degree of risk to the fetus than others, and this article discusses the use of those psychotropics for which caution is warranted based on currently available evidence and clinical opinion. The psychotropics that will be highlighted here include paroxetine, monoamine oxidase inhibitors, lithium, valproate, carbamazepine, and benzodiazepines. We suggest caution with regards to their routine use or as a first-line treatment in pregnancy. Five benzodiazepines are category X according to the FDA and are therefore contraindicated in pregnancy. For all these medications it is important not to overlook the benefits of psychiatric stability from continued treatment and the harms of discontinuation, which include increased risk of relapse of the illness.