Expert Consultations: Real-World Answers

Prescribing in Pregnancy: What Every Psychiatrist Should Know – Interview

Published on June 1, 2025 Certification expiration date: June 1, 2028

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Helen Tellegen

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Highlights

Neonatal adaptation syndrome from SSRIs is typically mild and self-limiting. Discontinuing antidepressants before delivery increases maternal depression risk without improving outcomes.
If SSRI efficacy decreases in late pregnancy, increase the dose rather than switching medications to avoid introducing new exposures.
Lithium's therapeutic range should be maintained during pregnancy, unlike lamotrigine where clinical response guides dosing.

FDA Medication Risk Categories in Pregnancy

Helen Tellegen, PMHNP: The FDA discontinued the ABCDX risk categories for medications in pregnancy due to their oversimplification. What important considerations were missing from this system that could help prescribers make more informed decisions?

Amanda Koire, M.D.: The ABCDX risk categories had a fundamental flaw in that medications with minimal safety data often appeared to be the safest options.

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Learning Objectives:

After completing this activity, the learner will be able to:

Evaluate the risks and benefits of psychiatric medications during pregnancy using contemporary evidence-based approaches.
Implement appropriate monitoring and dosing adjustments for psychiatric medications throughout pregnancy and the postpartum period.
Develop effective communication strategies for discussing medication management decisions with pregnant patients.

Original Release Date: June 1, 2025

Expiration Date: June 1, 2028

Expert: Amanda Koire, M.D.

Medical Editors: Helen Tellegen, M.D., Flavio Guzmán, M.D.

Relevant Financial Disclosures:

None of the faculty, planners, and reviewers for this educational activity have relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Contact Information: For questions regarding the content or access to this activity, contact us at support@psychopharmacologyinstitute.com

Instructions for Participation and Credit:

Participants must complete the activity online during the valid credit period that is noted above.

Follow these steps to earn CME credit:

View the required educational content provided on this course page.
Complete the Post Activity Evaluation for providing the necessary feedback for continuing accreditation purposes and for the development of future activities. NOTE: Completing the Post Activity Evaluation after the quiz is required to receive the earned credits.
Download your certificate.

Accreditation Statement

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint providership of Medical Academy LLC and the Psychopharmacology Institute. Medical Academy is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation Statement

Medical Academy designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Amanda Koire, M.D.