Dodd Seetal, Berk Michael
Department of Clinical and Biomedical Sciences - Barwon Health, University of Melbourne, Geelong, Australia.
Curr Drug Saf. 2006 Jan;1(1):25-33. doi: 10.2174/157488606775252692.
Risks associated with pharmacological treatment of bipolar disorder are heightened during reproductive events. Treatments need to be planned with the mutual agreement of both the treating physician and the patient and tailored to the needs of the individual so as to minimise risk while providing adequate treatment. Conventional treatments have all been associated with teratogeny in first trimester exposure, lithium with cardiac malformation and valproate and carbamazepine with neural tube malformations. There have been an insufficient number of first trimester exposures to the newer anticonvulsant mood stabilisers, lamotrigine and oxcarbazepine, to determine whether there is a safety advantage in switching to these agents. Increasingly, atypical antipsychotics are being suggested as useful agents for the treatment of bipolar disorder. While not known to be teratogenic, there are other reproductive safety concerns associated with these agents. Bipolar disorder patients may be prescribed antidepressants, and many of these agents are associated with a low safety risk during reproductive events, however data regarding use of these agents are currently equivocal. Adverse outcomes from inadequate pharmacological prophylaxis have been documented for both the mother and the baby. Risks and benefits need to be carefully balanced based on an accurate review of the evidence.
双相情感障碍药物治疗的风险在生殖期会增加。治疗方案需要在治疗医生和患者双方共同同意的情况下制定，并根据个体需求进行调整，以便在提供充分治疗的同时将风险降至最低。传统治疗方法在孕早期接触时均与致畸性有关，锂盐与心脏畸形有关，丙戊酸盐和卡马西平与神经管畸形有关。孕早期接触新型抗惊厥情绪稳定剂拉莫三嗪和奥卡西平的案例数量不足，无法确定改用这些药物是否具有安全优势。越来越多的人建议使用非典型抗精神病药物治疗双相情感障碍。虽然这些药物尚无致畸性报道，但仍存在其他与生殖安全相关的问题。双相情感障碍患者可能会被开具抗抑郁药，其中许多药物在生殖期的安全风险较低，但目前关于这些药物使用的数据尚不明确。母亲和婴儿因药物预防不足而出现不良后果的情况已有记录。需要在准确评估证据的基础上仔细权衡风险和益处。
