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The Use of Psychotropic Medications with Breastfeeding Women
Applying the available evidence
Kim Usher
Head of the School of Nursing Sciences, James Cook University, Townsville QLD
Kim Foster
School of Nursing, James Cook University, Townsville QLD
Abstract
Breastfeeding women may be prescribed a psychotropic medication to treat a pre-existing illness such as bipolar disorder or schizophrenia, or to treat an illness that develops as a direct result of pregnancy and childbirth, such as depression. Mental health nurses are often not aware that many psychotropic medications are considered relatively safe for the infant as well as the breastfeeding woman.
This paper provides the clinician with an overview of the major psychotropic medications for breastfeeding women and outlines their potential impact on the infant. Guidelines for the use of these medications are also provided for mental health nurses based on the available evidence.
Keywords
breastfeeding, psychotropic medications, mental health nursing, evidence
References
American Academy of Pediatrics (2005) Breastfeeding and the use of human milk: policy statement. Pediatrics 115(2): 496-506.
Appleby L, Warner R, Whitton A and Faragher B (1997) A controlled study of fluoxetine and cognitive-behavioural counseling in the treatment of PND. British Medical Journal 314: 932-936.
Austin M-PV, Mitchell PB (1998) Use of psychotropic medications in breast-feeding women: acute and prophylactic treatment. Australian and New Zealand Journal of Psychiatry 32: 778-784.
Boath E, Bradley E and Henshaw C (2004) Women's views of antidepressants in the treatment of postnatal depression. Journal of Psychosomatic Obstetrics and Gynaecology 25(3-4): 221-233.
Bryant B, Knights K and Salerno E (2003) Pharmacology for Health Professionals, Mosby, Sydney.
Burt V, Suri R, Altschuler L, Stowe Z, Hendrick V and Muntean E (2001) The use of psychotropic medications during breast-feeding. American Journal of Psychiatry 158(7): 1001-1009.
Chaudron LH and Jefferson JW (2000) Mood stabilizers during breastfeeding: a review. Journal of Clinical Psychiatry 61(2): 78-89.
Chaves RG and Lamounier JA (2004) Breastfeeding and maternal medications. Journal of Pediatrics 80(5): S189-198.
Craig M and Abel K (2001) Prescribing for psychiatric disorders in pregnancy and lactation. Best Practice & Research Clinical Obstetrics and Gynaecology 15(6): 1013-1030.
Elwood PC, Pickering J, Gallacher JEJ, Hughes J and Davies D (2005) Long term effect of breast feeding: cognitive function in the Caerphilly cohort. Journal of Epidemiology & Community Health 59: 130-133.
Ernst CL and Goldberg JF (2002) The reproductive safety profile of mood stabilizers, atypical antipsychotics, and broad-spectrum psychotropics. Journal of Clinical Psychiatry 63(suppl 4): 42-55.
Gentile S (2004) Clinical utilization of atypical antipsychotics in pregnancy and lactation. The Annals of Pharmacotherapy 38(7): 1265-1271.
Gjere NA (2001) Psychopharmacology in pregnancy. Journal of Perinatal & Neonatal Nursing 14(4): 12-25.
Hale TW (2002) Medications and mothers' milk 10th edn. Amarillo, Texas: Pharmasoft.
Hale TW (2004) Maternal medications during breastfeeding. Clinical Obstetrics and Gynaecology 47(3): 696-711.
Hoffbrand S, Howard L and Crawley H (2001) Antidepressant treatment for post-natal depression. The Cochrane Database of Systematic Reviews Issue 2: Art. No CD002018. DOI: 10.1002/14651858.CD002018.
Howard L and Abel KM (2004) Safety of antipsychotic drugs for pregnant and breastfeeding women with non-affective psychosis. Editorial. British Medical Journal 329: 933-934.
Ilett KF, Hackett LP, Kristensen JH, Vaddadi KS, Gardiner SJ and Begg EJ (2004) Transfer of Risperidone and 9-Hydroxyrisperidone into human milk. The Annals of Pharmacotherapy 38: 273-276.
Iqbal MM, Gudlapalli SP, Ryan WG, Ryals T, Passman TE (2001) Effects of antimanic mood-stabilizing drugs on fetuses, neonates, and nursing infants. Southern Medical Journal 94(3): 304-322.
Lee A, Giesbrecht E, Dunn E and Ito S (2004) Letters to the Editor. Excretion of Quetiapine in breast milk. American Journal of Psychiatry 161(9): 1715-1716.
Malone K, Papagni K, Ramini S and Keltner N L (2004) Antidepressants, antipsychotics, benzodiazepines, and the breastfeeding dyad. Perspectives in Psychiatric Care 40(2): 73-86.
McKenna K, Einarson A, Levinson A and Gideon K (2004) Significant changes in antipsychotic drug use during pregnancy. Veterinary & Human Toxicology 46(1): 44-46.
Oates M (2003) Perinatal psychiatric disorders: a leading cause of maternal morbidity and mortality. The British Medical Bulletin 67: 219-229.
Olds SB, London ML, Ladewig PW and Davidson MR (2004) Maternal-Newborn Nursing and Women's Health Care 7th edn. Upper Saddle River: Prentice Hall.
Piontek CM, Baab S, Peindl KS and Wisner K (2000) Serum valproate levels in six breastfeeding mother-infant pairs. Journal of Clinical Psychiatry 61(3): 170-172.
Spear HJ (2004) When reality does not meet expectations: the importance of consistent communication, support, and anticipatory guidance for high-risk mothers who plan to breastfeed. Journal of Clinical Nursing 13: 773-775.
Sved Williams A (2004) Infants of mothers with mental illness. In Cowling V (ed) Children of Parents with Mental Illness 2: Personal and Clinical Perspectives, pp.17-40. Melbourne: ACER Press.
Tenyi T, Csabi G and Trixler M (2000) Antipsychotics and Breast-Feeding: A Review of the Literature. Paediatric Drugs 2(1): 23-28.
Therapeutic Guidelines Ltd (2003) Therapeutic Guidelines: Psychotropic 5th edn. North Melbourne: Therapeutic Guidelines Ltd.
Trixler M and Tenyi T (1997) Antipsychotic use in pregnancy. Drug Safety 16(6): 403-410.
Viguera AC and Cohen LS (1998) The course and management of bipolar disorder during pregnancy. Psychopharmacology Bulletin 34(3): 339-353.
Welch R and Findlay J (1981) Excretion of drugs in human breast milk. Drug Metabolism Review 12: 261-277.
Winans E (2001) Antipsychotics and breastfeeding. Journal of Human Lactation 17(4): 344-347.
Yoshida K, Smith B, Craggs M and Kumar R (1998) Neuroleptic drugs in breast-milk: a study of pharmacokinetics and of possible adverse effects in breast-fed infants. Psychological Medicine 28: 81-91.
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