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Risks, benefits, alternatives, and appropriateness of psychotropic medications, including risks of no treatment, are discussed for antidepressants, mood-stabilizing medications, anxiolytic/sedative hypnotic medications, stimulants, and medication-assisted treatment of substance use disorders. Early screening, diagnosis, and intervention prior to and/or during pregnancy often reduce morbidity and mortality of mental health disorders for mothers and infants.

ABSTRACTPregnancy has frequently been described as a time of affective well-being. However, a growing literature suggests that women are neither “protected” against new-onset or recurrence of depression during this time. Diagnosis and effective treatment of depression during pregnancy requires a careful weighing of risk of treatment which may include psychotropic medications against the risks associated with failure to adequately manage affective distress and its potential impact of maternal and fetal well-being. Treatment options during pregnancy are reviewed in the context of developing the most appropriate risk/benefit decision for individual patients with past or current depression who either anticipate pregnancy or who become pregnant.

Background: Challenges for the clinical management of bipolar disorder (BD) during pregnancy are multiple and complex and include competing risks to mother and offspring.Method: We reviewed recent research findings on the course of BD during pregnancy and postpartum, as well as reproductive safety data on the major mood stabilizers.Results: Pregnancy, and especially the postpartum period, are associated with a high risk for recurrence of BD. This risk appears to be limited by mood-stabilizing treatments and markedly increased by the abrupt discontinuation of such treatments. However, drugs used to treat or protect against recurrences of BD vary markedly in teratogenic potential: there are low risks with typical neuroleptics, moderate risks with lithium, higher risks with older anticonvulsants such as valproic acid and carbamazepine, and virtually unknown risks with other newer-generation anticonvulsants and atypical antipsychotics (ATPs).Conclusions: Clinical management of BD through pregnancy and postpartum calls for balanced assessments of maternal and fetal risks and benefits.Contexte: Les problèmes liés au traitement clinique du trouble bipolaire (TB) durant la grossesse sont profonds et peuvent entraîner des risques concurrents pour la mère et l'enfant.Méthode: Nous avons examiné les résultats récents de la recherche sur le cours du TB durant la grossesse et le post-partum, de même que les données d'innocuité reproductrice des principaux régulateurs de l'humeur.Résultats: La grossesse et surtout la période du post-partum comportent des risques élevés de récurrence du TB. Les risques semblent être limités par les traitements aux régulateurs de l'humeur et notablement accrus par la cessation abrupte de ces traitements. Toutefois, les médicaments utilisés pour traiter ou prévenir les récurrences du TB varient beaucoup en ce qui concerne les risques tératogènes: les risques sont faibles pour les neuroleptiques typiques, modérés pour le lithium, élevés pour les anciens anticonvulsivants comme l'acide valproïque et la carbamazépine, et presque inconnus pour les autres anticonvulsivants de la nouvelle génération et les antipsychotiques atypiques (APA).Conclusions: Le traitement clinique des femmes souffrant du TB durant la grossesse et le post-partum demande des évaluations équilibrées des risques et des avantages pour la mère et le foetus.

Recent evolutionary models of reproductive partitioning within animal societies (known as ‘optimal skew’,‘concessions’ or ‘transactional’ models) predict that a dominant individual will often yield some fraction of the group's reproduction to a subordinate as an incentive to stay in the group and help rear the dominant's offspring. These models quantitatively predict how the magnitude of the subordinate's ‘staying incentive’ will vary with the genetic relatedness between dominant and subordinate, the overall expected group output and the subordinate's expected output if it breeds solitarily. We report that these predictions accord remarkably well with the observed reproductive partitioning between conesting dominant and subordinate queens in the social paper wasp Polistes fuscatus. In particular, the theory correctly predicts that (i) the dominant's share of reproduction, i.e. the skew, increases as the colony cycle progresses and (ii) the skew is positively associated both with the colony's productivity and with the relatedness between dominant and subordinate. Moreover, aggression between foundresses positively correlated with the skew, as predicted by transactional but not alternative tug-of-war models of societal evolution. Thus, our results provide the strongest quantitative support yet for a unifying model of social evolution.

Queens of hymenopteran social parasites manipulate the workers of other social species into raising their offspring. However, nonconspecific brood care may also allow the parasite larvae to control their own development to a greater extent than possible in nonparasitic species. An evolutionary consequence of this may be the loss of the parasite's worker caste if the larvae can increase their fitness by developing into sexuals rather than workers. We argue that this loss is particularly likely in species in which there is little inclusive fitness benefit in working. Retention of a worker caste correlates with characteristics that increase the fitness of working relative to becoming a sexual, such as worker‐production of males, high intracolony relatedness, and seasonal environments where the hosts of potential parasite queens are not always available. Further evidence strongly suggests that when the worker caste is evolutionarily lost in perennial species like ants, it disappears rapidly and through a reduction in caste threshold and queen size, so that parasite larvae become queens with less food than required to produce host workers. This evolutionary process, however, appears to lower overall population fitness, resulting in workerless parasite species having small populations and being geographically restricted. Conversely, in annual species like bees and wasps, workerless social parasitism evolves with no size reduction in queens, which is consistent with an expected lower level of queen/offspring conflict.

We have evaluated the capacity of dendritic cells to function as antigen-presenting cells (APCs) for influenza and have examined their mechanism of action. Virus-pulsed dendritic cells were 100 times more efficient than bulk spleen cells in stimulating cytotoxic T lymphocyte (CTL) formation. The induction of CTLs required neither exogenous lymphokines nor APCs in the responding T cell population. Infectious virus entered dendritic cells through intracellular acidic vacuoles and directed the synthesis of several viral proteins. If ultraviolet (UV)-inactivated or bromelain-treated viruses were used, viral protein synthesis could not be detected, and there was poor induction of CTLs. This indicated that dendritic cells were not capable of processing noninfectious virus onto major histocompatibility complex (MHC) class I molecules. However, UV-inactivated and bromelain-treated viruses were presented efficiently to class II-restricted CD4+ T cells. The CD4+ T cells crossreacted with different strains of influenza and markedly amplified CTL formation. Cell lines that lacked MHC class II, and consequently the capacity to stimulate CD4+ T cells, failed to induce CTLs unless helper lymphokines were added. Similarly, dendritic cells pulsed with the MHC class I-restricted nucleoprotein 147-155 peptide were poor stimulators in the absence of exogenous helper factors. We conclude that the function of dendritic cells as APCs for the generation of virus-specific CTLs in vitro depends measurably upon: (a) charging class I molecules with peptides derived from endogenously synthesized viral antigens, and (b) stimulating a strong CD4+ helper T cell response.

Using a series of kin‐selection models, I examine factors that favor multiple egg‐laying queens (polygyny) in eusocial Hymenoptera colonies. One result is that there is a theoretical conflict of interest between the founding queens and their daughter workers over how many and which individuals should be the extra reproductives. Both castes should prefer their full sisters. Therefore, primary polygyny (multiple related foundresses) may favor queens while secondary polygyny (related queens added to mature colonies) may favor workers. Polygyny, itself, was found to be favored by high colony survivorship and low probability of queens contributing eggs to successive broods. Polygyne colonies, however, did not need to produce more offspring per brood to be selectively favored; they could be half as productive per brood as monogyne ones and still have higher lifetime fitness under some conditions. For reproductive data from eight ant species with both monogyne and polygyne colonies, the model generates results that are consistent with a kin‐selection explanation of polygyny in all of them. It is proposed that queen number is an ecologically flexible trait that is influenced by a broad set of factors but is not necessarily linked to specific habitat types. Furthermore, neither polygyny nor monogyny may be reliably considered as the primitive or ancestral Hymenopteran social system. The optimal queen number within a species may evolutionarily increase or decrease, depending on the direction of environmental change.

Trivers and Hare (1976) predicted that the degree of genetic relatedness between hymenopteran workers and their brood is a fundamental factor in influencing the amount of resource allocated to the sexes. An analysis of a wide body of literature on ants (Family: Formicidae) strongly supports this genetic relatedness hypothesis (GRH). Their predictions on the differences in investment between monogynous, polygynous, slavemaking, and parasitic colonies are supported qualitatively and quantitatively both across and within species. Another explanation of female bias, local mate competition (LMC) (e.g., Alexander and Sherman, 1977), is found to be inconsistent with the data. The ratio of investment in species with non-conspecific brood care, most colonies producing either extremely male or female biased broods, as well as the suggestion that male ants may be highly limited in the number of females they can fertilize, are incompatible with LMC predictions. A limitation in the number of matings on the part of an individual male may mean that mating strategies in ant sexes could be quite different from those in most other species. The bimodal sexual investment pattern appears to be a mixed "evolutionary stable strategy and state" and seems proximately determined by the amount of food resources. Abundance favors females, scarcity favors males. Further utilization of game theory approaches may be quite useful in explaining both individual colony and population-level sexual investment values.

Nongravid individuals are known to be at high risk of having a relapse of depression if antidepressant therapy is discontinued. Pregnant women presumably are also at risk, despite the long held view of pregnancy as somehow protecting against psychiatric illness. This prospective study compared the risk of relapse in pregnant women who maintained or discontinued antidepressive drug treatment. The participants were 201 pregnant women cared for at centers expert in managing psychiatric disorders during pregnancy. All of them had a history of major depression before pregnancy, were at less than 16 weeks gestation, and had been euthymic for at least 3 months before the last menses. The women were currently receiving antidepressant therapy or had received it within 12 weeks before the last menstrual period.

Traditional thinking is that pregnancy may protect against recurrent major affective disorder or suicide, but supporting data are very limited. Recent reports suggest that the risk of bipolar illness is not altered. Both mania and bipolar depression are not uncommon in pregnancy, and many pregnant women have safely taken lithium. This study retrospectively examined the risk of recurrence in pregnant and nongravid women with a DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington, DC American Psychiatric Association, 1994) diagnosis of bipolar I or II disorder who chose to stop taking lithium. The 42 pregnant and 59 nonpregnant women, ranging in age from 16 to 50 years, discontinued lithium either rapidly (within 2 weeks) or gradually (within 15–30 days). The pregnant and nonpregnant groups were similar at the outset in age when illness began, the proportion with bipolar I disorder, and previous episodes of illness. Proportionally more pregnant women withdrew rapidly from lithium.

Despite the prevalence of postpartum depression, few studies have assessed the efficacy of antidepressants for the treatment of this disorder. Failure to treat postpartum depression (PPD) places the woman at risk for chronic depression and may have adverse effects on child wellbeing and development. Eight female outpatients aged 18–45 yr were enrolled in an 8-wk open-label trial of bupropion SR for PPD. All patients met DSM-IV criteria for major depression with onset within 3 months of delivery and scored 17 or greater on the Hamilton Depression Rating Scale (HAMD) at baseline. Those with onset of depressive symptoms during pregnancy, psychotic symptoms, or significant medical illness were excluded. Median scores on the HAMD declined from 20.5 (range 15–38) at baseline to 10.0 (range 1–20) at end-point (p<0.05, Wilcoxon signed-ranks test; LOCF). Six out of the eight subjects demonstrated a 50% decrease in HAMD scores from baseline; three subjects achieved remission (HAMD score of 7) at week 8. Median final dosage of bupropion SR was 262.5 (range 37.5–300). Bupropion SR was well tolerated, and no subjects discontinued treatment as a result of medication side-effects. Bupropion SR represents an effective and well-tolerated antidepressant for the treatment of PPD.