Any discussion of psychiatric medications and breastfeeding must begin with the benefits of breastfeeding, which are substantial. While all psychotropic medications enter the breast milk, medication exposure for a nursing infant is much less than the exposure to a fetus during pregnancy.

Dr. Hendrick, earlier this decade, most experts felt that SSRIs were relatively safe in pregnancy, but lately the pendulum seems to be swinging in the other direction. What do you consider to be the major risks of SSRIs in pregnancy?

Sildefanil (Viagra) has been shown helpful in treating antidepressant-induced sexual dysfunction (AISD) in men, but no controlled trials had tested its effectiveness in women. In this trial, 98 women with SSRI associated sexual dysfunction were randomly assigned to either sildefanil or placebo; all participants continued their SSRI, and their sexual functioning was assessed at multiple times.

Although we tend to feel comfortable counseling patients to continue antidepressants during pregnancy, because most of them do not appear to cause congenital abnormalities, mood stabilizers are trickier.

Every month seems to bring a new FDA advisory or an alarming research finding about the use of medications in pregnancy. In this article, we update you on what we consider to be the most important developments over the past couple of years.

Over the last several years, we’ve all seen many FDA warnings and cautionary letters from drug companies about the effects of psychotropics in pregnancy. As a result, it’s easy to become a little skittish about prescribing any medication for pregnant women.

Dr. Brizendine, as the director of the UCSF Women’s Mood and Hormone Clinic, you receive many referrals of women who are having difficulty with menopause. What are the typical problems that women have during this period?