Perinatal psychopharmacology for PMHNPs: which SSRI to start, how lamotrigine clearance shifts by trimester, lactation RID numbers, and when to escalate. In this Deep Dive episode, two hosts walk through “Perinatal Psychopharmacology: PMHNP Protocol 2026” from the Psych NP Fellowship blog by Lindsay Hill, DNP, PMHNP-BC. Key takeaways: • Lamotrigine clearance climbs roughly 80% in the first trimester and about 200% by the second, so a stable preconception dose quietly becomes a subtherapeutic one. • Sertraline and escitalopram are the preferred first-line SSRIs; sertraline's relative infant dose in breast milk is about 0.5%. • ACOG advises against withholding or stopping psychiatric medication on the basis of pregnancy or lactation status alone. • Valproate stays off the table: about 1-2% neural tube defect risk and malformation rates reported near ...