Pharmacotherapy for depression and bipolar disorder during lactation: A framework to aid decision making

• Published in: Seminars in perinatology 2020-04, Vol.44 (3), p.151224-151224, Article 151224
• Main Authors: Sprague, Jennifer, Wisner, Katherine L., Bogen, Debra L.
• Format: Article
• Language: English
• Subjects: bipolar disorder; breastfeed; breastmilk; depression; lactation; medications
• ISSN: 0146-0005; 1558-075X
• DOI: 10.1016/j.semperi.2020.151224

Breastmilk is recommended as the exclusive source of nutrition for infants younger than 6 months due to the numerous health benefits for both infants and mothers. Although many women are prescribed medications during pregnancy and postpartum, limited data are available to assist women in weighing the benefits compared to the risks of peripartum medication use. The goals of this paper are to discuss the importance of breastmilk for the health of both the mother and infant, evaluate the impact of medication use on women's infant feeding choice, describe the transfer of drugs to breastmilk and infants, and provide a framework for clinicians to support evidence-based counseling for women treated for mood disorders. We recommend early pregnancy counseling to discuss the benefits and risks of medications during breastfeeding. The Surgeon General's Call to Action (2011) highlights the short and long-term negative health effects of not providing breastmilk. Integrating recommendations from the pediatric and obstetric teams allows patients to make decisions based on evidence and reach their infant feeding goals. Databases containing summaries of research findings and pharmacologic properties of the drug of interest are an essential resource for clinicians.