Intended for healthcare professionals

Clinical Review State of the Art Review

Management of psychotropic drugs during pregnancy

BMJ 2016; 352 doi: (Published 20 January 2016) Cite this as: BMJ 2016;352:h5918
  1. Margaret S Chisolm, associate professor of psychiatry1,
  2. Jennifer L Payne, associate professor of psychiatry1
  1. 1Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
  1. Correspondence to: J L Payne, MD, Women’s Mood Disorders Center, Baltimore, MD 21205, USA Jpayne5{at}


Psychiatric conditions (including substance misuse disorders) are serious, potentially life threatening illnesses that can be successfully treated by psychotropic drugs, even during pregnancy. Because few rigorously designed prospective studies have examined the safety of these drugs during pregnancy, the default clinical recommendation has been to discontinue them, especially during the first trimester. However, in the past decade, as more evidence has accumulated, it seems that most psychotropic drugs are relatively safe to use in pregnancy and that not using them when indicated for serious psychiatric illness poses a greater risk to both mother and child, including tragic outcomes like suicide and infanticide. This review presents an up to date and careful examination of the most rigorous scientific studies on the effects of psychotropic drugs in pregnancy. The lack of evidence in several areas means that definite conclusions cannot be made about the risks and benefits of all psychotropic drug use in pregnancy.


  • Contributors: Both authors planned, conducted, and prepared for publication all the review work described in this article; they both act as guarantors. Both authors also accept full responsibility for the work and the conduct of the study, had access to the data, and controlled the decision to publish. The authors acknowledge the assistance of informationist Blair Anton who contributed to the search strategy and research assistant Elizabeth Uible who organized the literature identified by the search.

  • Competing interests: We have read and understood BMJ policy on declaration of interests and declare the following: MSC: no support from any organization for the submitted work and no competing interests. JLP: No support from any organization for the submitted work. JLP has received legal consulting fees from Astra Zeneca, Johnson and Johnson, Pfizer, and Eli Lilly.

  • Provenance and peer review: Commissioned; externally peer reviewed.

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