by Anne Eglash MD, IBCLC, FABM
Women with a history of bipolar disorder have a high risk of symptom recurrence within the first 4 weeks postpartum, particularly if they had discontinued treatment, according to authors of a 2016 systematic review on treatment of bipolar disorder during breastfeeding
This study reviews the safety and risks of anti-psychotic and mood stabilizing medications during breastfeeding for both the mother and child.
What do you think are accurate statements from this article, regarding bipolar disorder, medications, and breastfeeding? (choose more than 1)
- Breastfeeding increases the risk of worsening bipolar disorder symptoms.
- Women with a history of bipolar disorder have a higher risk of postpartum psychosis.
- Recent evidence indicates that lithium use during breastfeeding appears to be safe based on low lithium levels in infants. An individualized approach should still be taken in monitoring the infant for adverse side effects.
- Women may breastfeed if using anti-epileptic medications for mood stabilization, including carbamazepine, lamotrigine, phenytoin, and valproate.
- The safest anti-psychotics for breastfeeding appear to be quetiapine and olanzapine.
See the Answer
The answer is 2, 3, 4, 5
Link to Abstract
Abstract
Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder.
Pacchiarotti I, León-Caballero J, Murru A, Verdolini N, Furio MA, Pancheri C, Valentí M1, Samalin L, Roigé ES, González-Pinto A, Montes JM, Benabarre A, Crespo JM, de Dios Perrino C, Goikolea JM, Gutiérrez-Rojas L, Carvalho AF, Vieta E.
Breast milk is considered the best source of nutrients and provides much better protection than immune modified milk. However, the postpartum period is a phase of increased risk for all women to experience psychiatric symptoms and recurrences or new episodes of bipolar disorder (BD), especially in those who have discontinued treatment. This is a systematic review of the risks and benefits of mood stabilizers and antipsychotics during breastfeeding as they relate to the health and well-being of mothers and their infants. Evidence-based treatment advice for women with BD during lactation is also provided. This systematic review has been conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We included studies examining the exposure and the effects of antipsychotics and mood stabilizers used to treat BD on infants during breastfeeding clearly reporting the estimated amount of drug or effects on infants. The final selection included 56 studies. The available data supports the use of lithium as a possible treatment option during breastfeeding. Carbamazepine and valproic acid are also considered relatively safe. Lamotrigine can be used but at the lowest doses and considered for individual cases. Among the antipsychotics, quetiapine and olanzapine should be considered as first-line treatment options. Risperidone may be compatible with breastfeeding under medical supervision. Clozapine and amisulpiride are currently contraindicated. Long-term outcome studies evaluating the infant׳s health and psychosocial and cognitive functioning are needed.
Milk Mob Comment by Anne Eglash MD, IBCLC, FABM
This article is an excellent review of psychiatric medications for women who have psychosis or bipolar disorder. These are challenging psychiatric medications to recommend during breastfeeding because many providers worry about the risks to infants. Fortunately there are several anti-psychotics and mood stabilizers that are considered reasonably safe to take. There are a few medications that are not recommended by these authors because of lack of data on safety. These include clozapine, amisulpiride, aripiprazole, lurasidone, ziprasidone, asenapine, and loxapine.
The authors point out that we need much more research on the long term health effects of infant exposure to most psychoactive medication.