Literature Collection

The increasing use of antidepressants, escalating rates of unintended pregnancy, and disproportionately high rate of maternal suicide in the United States, as compared with other high-income countries, all highlight the urgent need for more clarity on available treatment options for perinatal depression. Misrepresentative data obtained from animal experiments and observational human studies, many of which do not account for underlying mental illness as a confounder, largely overestimate the teratogenicity of antidepressants. These outdated data-coupled with a lack of clear guidance from leading agencies-have created a healthcare scenario rife with decisional conflict. As general practitioners frequently serve as patients' first point of contact within the US healthcare system, primary care is central to preconception and mental health management. This article educates primary care providers on the risks of untreated perinatal depression and the realities of antidepressant teratogenicity. Doubling as a narrative review, the article also synthesizes available evidence to provide a risk-based guide for treatment with antidepressants that emphasizes a shared decision-making approach.

Opioid abuse and dependence continues to rise in both the general population and pregnancy, with opioid overdose deaths having quadrupled in the last 15 years. Illicit drug use in last 30 days of pregnancy was over 4% with almost 0.6% documented maternal opiate use at time of birth. The management of the opioid-tolerant, buprenorphine-dependent or methadone-dependent patient in the peripartum period is reviewed. Options for treatment of opioid dependence, acute pain management, and perioperative multimodal analgesia are discussed. The effects of maternal management on neonatal abstinence syndrome are also reviewed.

Patients who suffer from personality disorders often exhibit self-destructive behaviors in the clinical setting and are noncompliant. By recognizing the disorder and intervening, primary care providers can help improve patient outcomes and minimize damaging clinical interactions. This article discusses the different types of personality disorders and provides diagnosis, treatment, and referral guidelines.