Is there a known hierarchy of risk associated with psychiatric medications?
The least safe drugs are likely the ones that women with more severe conditions benefit from. For example, divalproex and carbamazepine are teratogens. Lithium, which has been thought to be a teratogen, is probably less problematic than originally believed. The anticonvulsants are probably worse than lithium. Antidepressants are being viewed differently now as well. Although it was believed that newer selective SRIs were benign as a class, more recent data suggest that there may be risks associated with them. Pulmonary hypertension has been associated with the use of SRIs during the second half of pregnancy, after 20 weeks. Persistent pulmonary hypertension can be a very serious illness. It can be lethal, though not all cases are serious. There is a range of outcomes. Caution is advised, as the significant findings are based on a single case control study3 and replication is necessary before definitive conclusions can be drawn. However, in this case-control study there was a six-fold i
