There's one med you should never use in a pregnant woman.

And new guidelines suggest avoiding it in women of reproductive age altogether.

Welcome to the Carlyte Psychiatry Podcast, keeping psychiatry honest since 2003.

I'm Chris Aiken, the editor-in-chief.

And I'm Kelly Newsom, a psych-n-p and a dedicated reader of every issue.

Before we release the Ninth Commandment, let's recap the first eight.

1. Do not worsen mental illness with psychiatric medications,

like don't use antidepressants in rapid cycling bipolar disorder or psychostimulants

in psychosis.

Two, avoid stopping meds abruptly, particularly benzodiazepines and serotonergics.

Three, prevent lithium toxicity by checking interactions, age, and renal function.

Four, stop Lomotrogen if any rash develops in the first three months.

5. Do not combine benzodiazepines and opioids in patients at high risk for overdose death.

6. Honor thy M-A-O-I interactions.

7. Controlled substances shall be controlled by you.

Eight, avoid unwise medication combinations like benzos and stimulants or stimulants

and antipsychotics.

And number nine, avoid valproate, depicote in pregnancy.

And we could end this podcast there, but come with us because we've got a lot

to say on this one. Valproate is the only psychiatric medication with a near absolute contraindication

in pregnancy. The risks here are clear. There's congenital malformations, including spina bifida, facial malformations,

neurotube defects, cleft lift and palate, hypospadia, which is a defect in the opening of the penis,

...