Dr. Forray gives readers a comprehensive refresher on fetal effects of alcohol, tobacco, opioid, cannabis, and stimulant use during pregnancy. She then lays out the current evidence for various treatments and provides recommendations for how to treat pregnant patients with addiction.

Imagine working with a pregnant, mentally ill woman who refuses critical obstetric interventions. Dr. Syed walks us through the steps to determine if these patients lack decisional capacity and explains how we can arrange for surrogate decision-makers.

Buspirone (Buspar) is approved for generalized anxiety disorder, but its efficacy there is often questioned. Here we find out how it stacks up against the benzos and SSRIs, and explore its off-label potential in depression, sexual dysfunction, alcoholism, traumatic brain injury, and premenstrual dysphoric disorder.

Every week of depression takes a toll on infant development, so this rapid-acting treatment fills a unique need. Here we review the clinical data and the pragmatics of getting patients connected with the therapy.

During pregnancy, untreated depression significantly increases the risk that the infant will fail to develop adequate levels of cerebral inhibition. That’s a measure of the infant’s ability to filter out irrelevant stimuli, and it’s the first sign that development is not on an optimal track.

There’s nothing like a close friend suffering psychiatric difficulties to motivate a psychiatrist to do some serious reading. Recently, your humble editor encountered this situation.

You may not know it, but this year marks a milestone in the world of SSRI teratology research. Ten years ago, JAMA published the first controlled study of Prozac exposure in pregnancy (1). The results? Neither Prozac nor tricyclics caused more birth defects than controls, but both antidepressants caused more neonatal complications.

Dr. Hendrick, there has been a lot of confusing and seemingly contradictory data about the safety of SSRIs during pregnancy. What’s your take?

Roseann Gumina, M.D., is an obstetrician/gynecologist in private practice in Milwaukee, Wisconsin. Like most OB/GYNs, Dr. Gumina sees more pregnant women on antidepressants in a given year than most psychiatrists are likely to see in a lifetime, and her perspective is informative.