Clin Drug Invest 2008; 28 (11): 735-739 CASE REPORT 1173-2563/08/0011-0735/$48.00/0  2008 Adis Data Information BV. All rights reserved. Use of Escitalopram during Pregnancy Navigating Towards International Guidelines and the Real World Salvatore Gentile Mental Health Center n. 4 – Department of Mental Health, ASL Salerno 1, Italy Maternal psychiatric disorders commonly considered as moderate may have a Abstract devastating impact on the fetus and the newborn. Thus, treating or preventing relapse of these disorders during pregnancy is a clinical and ethical duty, despite the fact that the need for rapid maternal symptomatological improvement appears to be at odds with the necessity to avoid fetal drug exposure. Several guidelines and comprehensive reviews have been published to help clinicians faced with this difficult clinical decision. However, the uptake of these recommendations into clinical practice appears to have been less than complete, as suggested by the present case of a patient who was administered escitalopram throughout preg- nancy. In this case, there was a healthy outcome for the child. However, this should not detract from the necessity to tackle the problem of inappropriate prescribing of psychotropic agents in pregnancy. Utilization of an integrated clinical approach, monitoring of drug levels throughout pregnancy and routine documentation of the health of the neonate are important measures that should be implemented and promoted to ensure optimal management of antenatal psychiat- ric disorders and minimize the effects of treatment on the newborn. Background of prematurity and low birthweight. [3,4] Maternal panic disorder may also induce relevant changes in While the major focus of current scientific re- children’s neurophysiology (such as elevated sali- search is on the risks posed to the mother-infant pair vary cortisol levels and disturbed sleep) and beha- of untreated severe mental illness during preg- viour (including inhibited temperament or attach- nancy, [1] maternal psychiatric disorders commonly ment difficulties). [5,6] Thus, treating or preventing a considered as moderate may also have a devastating relapse of panic disorder during pregnancy is a impact on the fetus and the newborn. Specifically, clinical and ethical duty, despite the fact that the untreated panic disorder has been associated with an need for rapid maternal symptomatological im- increase in the rate of isolated cleft/lip palate and provement appears to clash with the necessity to multiple congenital abnormalities. [2] Infants born to avoid fetal drug exposure. Several guidelines and mothers with this disorder are also at increased risk comprehensive reviews have been published to help