The Use of Mood Stabilizers During Breastfeeding

The literature and majority of professional organizations endorse breastfeeding as a means to provide a number of health benefits to both mother and child. Notably, the postpartum period heralds an increased vulnerability for both new onset and symptom worsening of neuropsychiatric disorders, particularly bipolar disorder in women. While pharmacologic treatment is important for these patients, many physicians have been hesitant to prescribe medication for women who choose to breastfeed, despite the fact that a variety of medical illnesses are routinely treated in breastfeeding women (e.g., epilepsy, infection, allergies, and migraine) and that nursing infants may also directly receive medications for colic and reflux. To date, all psychotropic medications studied enter human breast milk, and many of these medications have undergone detailed investigations. While breastfeeding may complicate pharmacotherapy, it does not preclude it. There are limited scientifically derived guidelines in the treatment of women who choose to breast-feed. The pharmacokinetic properties and potential impact of infant exposure to mood stabilizers must be considered in the decision to breastfeed infants born to mothers receiving pharmacologic treatment for bipolar disorder. Past practices and methodologies for determining continuation of treatment are discussed in this article, as well as the current data for newer categories of drugs being used to treat bipolar disorder and their indications during pregnancy and breastfeeding. Treating pregnant women with neuropsychiatric illnesses in their childbearing years who are breastfeeding involves a thorough risk:benefit analysis to determine the relative safety of pharmacologic therapy. Familiarity with the extant literature and its limitations and practical considerations will enable optimizing treatment plans that maintain maternal mental health, minimize nursing infant exposures, and provide infant monitoring.