Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counselling

Objective: To assess the consequences to mother and baby of abruptly discon tinuing antidepressant or benzodiazepine medication during pregnancy and to assess the impact of our counselling. Participants: All women who consulte d the Motherisk Program between November 1996 and December 1997 and who sto pped taking antidepressant or benzodiazepine medication when pregnancy was confirmed agreed to participate in the study. Design and interventions: Sub jects were interviewed, received counselling, and completed a questionnaire I month after their initial call and after the birth of their baby. Result s: Of 36 women who completed the study, 34 discontinued their medication ab ruptly for fear of harming the fetus, 28 on the advice of their physician; 26 (70.3%) women reported physical and psychological adverse effects, I I r eported psychological effects only, and ii reported suicidal ideation (4 we re admitted to hospital). After counselling, 22 of 36 (61.1%) women resumed taking their medication, and 4 found that they no longer required it. One woman had a therapeutic abortion and 2 experienced spontaneous abortions; t here were therefore 35 healthy babies (including 2 sets of twins) born to 3 3 women; 14 of 21 mothers breast-fed their babies while taking their psycho tropic medication, with no adverse effects reported. Conclusions: When asse ssing the risks and benefits of taking psychotropic medication during pregn ancy. women and their physicians should be aware that the abrupt discontinu ation of psychotropic drugs can lead to serious adverse effects. Counsellin g is effective in reassuring women to adhere to therapy.