Pharmacotherapeutic considerations for the treatment of post-traumatic stress disorder during and after pregnancy: an update

INTRODUCTION: Post-traumatic stress disorder (PTSD) is a debilitating mental disorder that can cause significant distress to patients and their families. It affects women disproportionately, presenting during pregnancy and the postpartum period. It often goes unrecognized and undertreated, with deleterious consequences for the mother and offspring. The first-line treatment for PTSD in pregnancy and during lactation is psychotherapy; however, when it is not feasible or effective, pharmacotherapy is preferred. AREAS COVERED: This is a narrative review discussing the efficacy and safety of different classes of psychoactive medications for PTSD during pregnancy and the postpartum period. Currently, there are no randomized controlled trials assessing the efficacy and safety of psychoactive medications specifically for PTSD during pregnancy and lactation. Therefore, guidelines recommend treatment with sertraline, paroxetine, or venlafaxine. EXPERT OPINION: Identifying pregnant or postpartum patients with high vulnerability for PTSD and promptly diagnosing, treating, and closely monitoring their response is crucial in the delivery of individualized, high-quality care. Few medications are recommended for the management of PTSD during pregnancy and lactation. In the future, research must focus on the development of safe and effective interventions to ensure the delivery of inclusive healthcare for women in all life stages.