Doi: 10.1176/appi.books.9780890425596.dsm06

 
9 minutes agoJennifer Moore-Fischer Main Post MooreFischer COLLAPSE
Cognitive Behavioral Therapy is the recommended first line treatment of OCD, especially during pregnancy (Iniesta-Sepúlveda and Storch, 2017).  CBT is also the non pharmaceutical intervention of choice (Viswasam, Eslick, and Starcevic, 2019). And truly, if the risks of pharmaceutical nontreatment  versus benefits gained by pharmaceutical treatment are weighed and pharmaceutical nontreatment is risked, then CBT should be heavily encouraged to keep mother and baby as healthy as possible during the pregnancy (Viswasam, Eslick, and Starcevic, 2019).
With the exception of paroxetine, SSRIs (Such as fluoxetine and sertraline) are the drugs of choice to treat Obsessive Compulsive Disorder in pregnancy, though they are secreted in small (considered relatively safe) amounts in breastmilk during breastfeeding (Bharadwaj et al., 2022). Paroxetine is of increased risk and should be avoided in favor of lower risk alternative SSRIs as previously listed (Burton et al, 2022).
Escitalopram (Lexapro) can be prescribed off label to treat OCD during pregnancy if fluoxetine and sertraline etc fail to relieve symptoms or cause significant side effects that fail their trial (Peggy, Cummings, and Mark, 2017). It should also be noted that Buspar is actually a category B drug for pregnancy use risk (Bharadwaj et al., 2022).
The risk assessment tool I woulod use during pregnancy for women struggling with OCD is the Perinatal Anxiety Screening Scale. The PASS screening can be used after a GAD7 indicates moderate to high anxiety, in the categories of: “… acute anxiety and adjustment, general worry and specific fears, perfectionism, control and trauma, and social anxiety” (Bharadwaj et al., 2022).   Potential side effects of SSRIs include dry mouth, insomnia, blurred vision, drowsiness, nausea, dizziness, nervousness, headaches, reduced libido, blurred vision (Bharadwaj et al., 2022).
The APA does publish regularly updated treatment guidelines for the assessment and treatment of OCD. They recommend use of CBT and SSRIs for appropriate ytreatment of OCD  (Viswasam, Eslick, and Starcevic, 2019).
References
American Psychiatric Association (APA). (2013). Diagnostic and statistical
manual of mental disorders (5th ed.). Arlington, VA: Author.
doi: 10.1176/appi.books.9780890425596.dsm06
Bharadwaj, B., Endumathi, R., Parial, S., & Chandra, P. (2022). Management of psychiatric disorders during the perinatal period. Indian Journal of Psychiatry, 64, 414–428. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_12_22
Burton, H. A. L., Pickenhan, L., Carson, C., Salkovskis, P., & Alderdice, F. (2022). How women
with obsessive compulsive disorder experience maternity care and mental health care during pregnancy and postpartum: A systematic literature review. Journal of Affective Disorders, 314, 1–18. https://doi.org/10.1016/j.jad.2022.06.041
Iniesta-Sepúlveda, M., & Storch, E. A. (2017). Cognitive-behavioral therapy as an effective,
safe, and acceptable intervention for OCD during pregnancy. Revista Brasileira de Psiquiatria, 39(1), 84. https://doi.org/10.1590/1516-4446-2016-1952
Peggy, L., Cummings, N., & Mark, T. (2017). Off-Label Prescribing of Psychotropic Medication, 2005–2013: An Examination of Potential Influences. Psychiatric Services, 68(6), 549–558. https://doi.org/10.1176/appi.ps.201500482
Viswasam, K., Eslick, G. D., & Starcevic, V. (2019). Prevalence, onset and course of anxiety disorders during pregnancy: A systematic review and meta analysis. Journal of Affective Disorders, 255, 27–40.

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