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The medicinal treatment of mental disorders during pregnancy and lactation requires special knowledge about possible effects of the psychopharmacotherapy on the intrauterine exposure of the embryo/fetus. Therefore, the first part of this 2‑part article focuses on the use of psychotropic drugs during pregnancy. In the second part, the use of psychotropic drugs during breastfeeding is addressed. Possible substance-specific risks as a consequence of the administration have to be assessed compared to the natural risk of pregnancy complications, birth complications and neonatal complications associated with the appropriate (untreated) mental disease. Pharmacokinetic changes during pregnancy require a special focus on the safety of drug treatment and treatment efficacy. Currently, neither the European Medicines Agency (EMA) nor the U. S. Food and Drug Administration (FDA) has approved any psychotropic drug for use during pregnancy or breastfeeding. A more detailed consideration of the risk profiles of all psychotropic drugs, prescribed off-label during this time, is important. Antidepressants, antipsychotics, and mood stabilizers are the main drugs used, despite their lack of approval. This first part of our 2‑part article provides an overview of the most frequently used substance groups during pregnancy and their special characteristics. Therapeutic drug monitoring (TDM) is presented as a clinical tool that can provide a supportive contribution to treatment safety and effectiveness during pregnancy and later also during breastfeeding, not only because of the changing pharmacokinetics. In this context, the measurement of concentrations of the active substance allows a better quantification of the intrauterine and postpartum exposure risk. Despite all clinical support possibilities, each therapeutic decision for the administration of a psychotropic drug remains an individual case decision. For those involved in the treatment, this means a careful balancing of the possible consequences of non-treatment and the possible sequelae of the use of psychopharmacotherapy. [ABSTRACT FROM AUTHOR]

The drug treatment of mental disorders during lactation requires special knowledge about the possible effects on the breastfed infant. The first part of this 2‑part article is devoted to the use of psychotropic drugs during pregnancy. This second part addresses the use of psychotropic drugs during breastfeeding. The uncertainty about whether maternal breastfeeding can be recommended during drug treatment is high and the clinical management of psychopharmacotherapy during breastfeeding is a major challenge. Due to sparse scientific evidence, the administration of psychotropic drugs must be evaluated individually; however, the risk of mental decompensation of the mother is a weighty factor that can have a very negative impact on the mother-child pair, in the worst case up to suicide or infanticide. Drug treatment during breastfeeding is always off-label and should therefore only be given after a careful risk assessment and comprehensive clarification. Every treatment decision is a case by case decision based on an assessment of the overall constellation. This includes the psychiatric history, the current complaints and a risk assessment for the infant, ideally with the involvement of a social support network in the environment. A multiprofessional support by psychiatrists, pediatricians, gynecologists and midwives should accompany drug treatment during breastfeeding under close monitoring. This second part of the 2‑part article provides an overview of the most frequently used drug classes during the breastfeeding period. Therapeutic drug monitoring (TDM) is a valuable tool for risk and exposure assessment during the breastfeeding period. [ABSTRACT FROM AUTHOR]

Background: Alongside depression, anxiety disorders are the most frequent reason for consulting a psychotherapist. Objective: This article describes the recent progress in understanding basic learning processes in anxiety treatment, the resulting therapeutic procedures, the current state of knowledge on the efficacy of the various psychotherapeutic procedures and on the moderators of the success of treatment. Material and methods: The English and German language literature was reviewed and compiled, with an emphasis on the last 10 years. Results: Cognitive-behavioral therapy (CBT) achieves the best and broadest level of evidence across all anxiety disorders. Initial studies have also provided emerging evidence for the efficacy of manualized short-term psychodynamic treatment. The most discussed mechanism of action is that of inhibitory learning. Augmentation strategies and personalized treatment approaches are gaining in relevance. Conclusion: Current models of inhibitory learning are rooted in basic research and foster a deeper understanding of the underlying neurobiological mechanisms. In order to optimize success of exposure treatment in vulnerable subgroups of patients, many procedural, device-based and pharmacological augmentation strategies are currently under investigation, whereby the latter are mostly still in the stage of (pre)clinical testing. [ABSTRACT FROM AUTHOR]