ABSTRACT
Although selective serotonin reuptake inhibitors can cause sexual dysfunction, it is important to understand the temporal sequence, i.e. which of these came first - starting antidepressants or the sexual dysfunction. Holly Bailey is a 35-year-old married woman in the out-patient clinic. She has a diagnosis of bipolar affective disorder. She is six weeks pregnant. She was discharged three months ago after a hypomanic episode. In the last five years she has been admitted four times, usually under the Mental Health Act. This is a classic scenario of a poorly controlled patient who has had four admissions in five years who becomes pregnant. The central issue is to balance the mental health needs of this patient with the risks to the foetus, i.e. if medication is stopped then she may relapse, posing risks to mother and foetus. Mrs Bailey gave birth to a healthy baby boy but her husband has become increasingly concerned about her mental health.
