MHM Magazine

dose reduction or switching to prolactin-sparing antipsychotics like Olanzapine, Quetiapine, Ziprasidone, Aripiprazole, or Clozapine can be attempted. The prevalence of hyperprolactinaemia with Risperidone is notably higher at 88%. Key points: antipsychotics in females • Avoid high-affinity D2 blockade antipsychotics (FGAs and Risperidone) that induce hyperprolactinaemia. • Hyperprolactinaemia causes hypogonadism, leading to anovulation, decreased libido, menstrual irregularities, and infertility. • Consider prolactin-sparing antipsychotics (SGAs except Risperidone and FGAs). Mood stabilisers in females • Lithium: Not directly associated with infertility, but may lower testosterone and increase prolactin levels, leading to amenorrhea and menstrual irregularities. • Sodium Valproate: Causes hyperandrogenaemia and hyperinsulinaemia, potentially leading to PCOS (Polycystic ovarian syndrome) and menstrual disorders. Weight gain is a common side effect and a negative factor in fertility management. Valproate should be avoided in females of childbearing age due to teratogenicity. • Lamotrigine: A safer alternative with no associated hormonal alterations or sexual dysfunction and low teratogenicity. Levels may be affected by contraceptives or hormonal treatments. • Carbamazepine and Oxcarbazepine: Do not significantly cause weight gain but may induce metabolism of steroid hormones, affecting the efficacy of hormonal treatments and leading to menstrual disorders and reduced fertility. Red Alert • Valproate should be avoided in females of childbearing age due to associated teratogenicity. • Supplementation with folic acid/folate does not decrease teratogenicity. Key Points: Mood Stabilisers in Females • Research is limited but lithium does not seem to significantly affect fertility or hormones. • Valproate causes hyperandrogenaemia, leading to PCOS, menstrual irregularities, sexual dysfunction, and infertility. • Carbamazepine and Oxcarbazepine interact with hormonal treatments and contraceptives, decreasing their efficacy. • Lamotrigine is a safer alternative, not associated with hormonal changes or sexual dysfunction, and is not teratogenic. Conclusion Understanding the impact of psychiatric medications on male and female fertility is crucial for guiding treatment decisions in the preconception phase. Collaborative care between psychiatrists, fertility specialists and general practitioners is essential to balance mental health needs with reproductive health, ensuring comprehensive patient care. Further research is needed to optimise treatment strategies for individuals planning to conceive. References available on request. MHM | 2025 | Volume 12 | Issue 1 | Psychiatric Medication and Fertility: Preconception Prescribing Considerations in Psychiatry MHM 8 | MENTAL HEALTH MATTERS | 2025 | Issue 1 H