Mood stabilizers and teratogenicity–prescribing practice and awareness amongst practising psychiatrists

Abstract

Background: Valproate, carbamazepine and lithium are widely used in psychiatry but are teratogenic and require special caution when prescribed for women of child-bearing age.

Aims: To evaluate the knowledge and stated practice of consultant psychiatrists with respect to the prescribing of these drugs to women of child-bearing age.

Method: Semi-structured interviews with 52 consultant psychiatrists.

Results: Most prescribers (79–96%, depending on the drug) used these drugs and most (81–86%) were more cautious when prescribing to women of child-bearing age. Fewer (17–28%) demonstrated good, specific awareness of the estimated teratogenic potential of the individual drugs. Reported practice was characterized by reluctance to discuss contraception with patients, failure to prescribe prophylactic folate and uncertainty about who was clinically responsible for these issues.

Conclusions: The consultant psychiatrists in this survey had gaps in their knowledge of how to prescribe these drugs in ways that minimized the risk of teratogenicity. If actual practice mirrors reported practice, some women are being put at risk.

Declarations of interest: DT has received a research grant and speaker honoraria from Sanofi-Synthelabo. CP has acted as a consultant for Eli Lilly. TREB has acted as a consultant for Servier, Johnson and Johnson and Bristol-Myers Squibb, and received a grant from Sanofi-Synthelabo.

Keywords:

• Lithium
• carbamazepine
• valproate
• folate
• mood stabilizer
• pregnancy
• teratogenicity
• women

Notes

1 Interviews were carried out within sites at South London & Maudsley and Oxleas NHS Foundation Trust, Pinewood House, Pinewood Place, Dartford, Kent DA2 7WG.