• Home
  • Store
    • Newsletter Subscriptions
    • Multimedia
    • Books
    • eBooks
    • ABPN SA Courses
    • Social Work Courses
  • CME Center
  • Multimedia
    • Podcast
    • Webinars
    • Blog
    • Psychiatry News Videos
    • Medication Guide Videos
  • Newsletters
    • General Psychiatry
    • Child Psychiatry
    • Addiction Treatment
    • Hospital Psychiatry
    • Geriatric Psychiatry
    • Psychotherapy and Social Work
  • FAQs
  • Med Fact Book App
  • Log In
  • Register
  • Welcome
  • Sign Out
  • Subscribe
Home » Breast Feeding and Psychiatric Medications: An Overview

Breast Feeding and Psychiatric Medications: An Overview

February 1, 2009
From The Carlat Psychiatry Report
Issue Links: Learning Objectives | Editorial Information | PDF of Issue
Dhwani Shah, MD

Any discussion of psychiatric medications and breastfeeding must begin with the benefits of breastfeeding, which are substantial. The American Academy of Pediatrics and other medical organizations recommend that mothers exclusively breastfeed during the first six months of the baby’s life. Breast milk is considered the perfect food for nourishing infants, and breast-fed babies have lower rates of allergies, rashes, diarrhea, ear infections, and hospital admissions. Mothers benefit as well, with decreased post-partum bleeding, an earlier return to prepregnancy weight, a decreased risk of both ovarian and breast cancer, and possibly a decreased risk of osteoporosis after menopause (Pediatrics 2005; 115:496-506).

While all psychotropic medications enter the breast milk, medication exposure for a nursing infant is much less than the exposure to a fetus during pregnancy. Most authorities recommend that nursing mothers take medication immediately after breast-feeding to maximize clearance of the drug before the next feeding. However, this is unlikely to be an effective strategy during the first few months, when infants are feeding every two to three hours. As is the case for pregnant women, it is important to work with breastfeeding women to find the lowest effective dose.

Two particularly useful websites for updated information on psychotropics in breastfeeding are www.emorywomensprogram.org (Emory) and www.womensmentalhealth.org (Massachusetts General Hospital).

Antidepressants

Most studies have found that the excretion of SSRIs into the breast milk is very low, in some cases literally undetectable. A few case reports have described the following adverse effects in infants exposed to SSRIs in breast milk: increased crying, decreased sleep, gastrointestinal distress and irritability. It is not always clear that the SSRIs are to blame, because such behaviors are quite common in unexposed infants as well. Several very small studies have demonstrated no adverse long term neurobehavioral effects of SSRIs (Gentile, CNS Drugs, 2005; 19: 623-633).

Tricyclic antidepressants have also been widely used, with only one adverse event reported to date, in which doxepin caused respiratory depression (Weissman, et al., Am J Psychiatry 2004;161:1066-1078). Nine case reports have been published regarding the use of venlafaxine and breastfeeding, with no adverse effects observed. There is one case report in the literature of an infant seizure associated with the use of bupropion in a nursing mother, but causality in this case was not clear.

Antianxiety Medications

Benzodiazepines with a relatively short half life and no active metabolites, such as lorazepam and oxazepam, are found in low concentrations in breast milk and are likely safe when used at relatively low doses on an as needed basis. CNS depressant effects have been observed in infants who have been exposed to diazepam through breast milk, presumably due to its long half life (Eberhard-Gran et al., CNS Drugs, 2006;20:187-198).

Mood Stabilizers

Although valproate and carbamazepine are listed as lactation risk category 2 (usually compatible with breastfeeding) there are no published studies of the neurobehavioral impact of either of these medications. In the 41 motherinfant patients studied, one episode of thrombocytopenia and anemia occurred in an infant exposed to valproate. Reported adverse effects of carbamazepine in breast milk include cholestatic hepatitis and hyperbilirubinemia (ACOG Practice
Bulletin, 2008;4: 1001-1020). A recent study of the nursing infants of 30 women using lamotrigine demonstrated no adverse events except for mild asymptomatic thrombocytosis in seven infants out of eight infants measured for this (Newport, et al, Pediatrics, 2008; 122:223-231). There have been no reported cases of lamotrigine-induced Stevens Johnson Syndrome in neonates. Most authorities, including the American Academy of Pediatrics, discourage the use of lithium because levels tend to be quite high in the breast milk, leading to the possibility of lithium toxicity in the infant. A recent study of 10 mother-infant pairs, however, demonstrated low lithium levels in nursing infants and no significant behavioral problems, although there were several instances of transient elevations in TSH, BUN and creatinine (Viguera, 2007; Am J Psychiatry;164:342-345).

Antipsychotic Medications

An older study of breastfed infants of women who used chlorpromazine demonstrated no developmental deficits at both 16 month and five year follow up. However, another study of three breastfeeding infants who were prescribed both chlorpromazine and haloperidol showed evidence of developmental delay at 12-18 months of age (ACOG Practice Bulletin, 2008;4: 1001-1020). There are only a handful of case reports and small studies on second generation antipsychotics. Although many of the case reports demonstrate no effects on the newborn, a recent review article by Gentile recommends avoiding clozapine because of the potential risk of agranulocytosis in the infant. (Gentile, J Clin Psychiatry, 2008;69:666-673).

TCPR Verdict:

Again, it’s risk vs. benefit based on not much data
General Psychiatry
KEYWORDS women's_issues_in_psychiatry
    www.thecarlatreport.com
    Issue Date: February 1, 2009
    SUBSCRIBE NOW
    Table Of Contents
    Psychotropics and Pregnancy: An Update
    Breast Feeding and Psychiatric Medications: An Overview
    Adverse Effects of SSRIs in Pregnancy
    Risperidone Shows Mixed Results in Augmenting Antidepressant Treatment
    Headache Is a Risk Factor For Suicidality
    DOWNLOAD NOW
    Featured Book
    • MFB7e_Print_App_Access.png

      Medication Fact Book for Psychiatric Practice, Seventh Edition (2024) - Regular Bound Book

      The updated 2024 reference guide covering the most commonly prescribed medications in psychiatry.
      READ MORE
    Featured Video
    • KarXT (Cobenfy)_ The Breakthrough Antipsychotic That Could Change Everything.jpg
      General Psychiatry

      KarXT (Cobenfy): The Breakthrough Antipsychotic That Could Change Everything

      Read More
    Featured Podcast
    • shutterstock_2622607431.jpg
      General Psychiatry

      Should You Test MTHFR?

      MTHFR is a...
      Listen now
    Recommended
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png
    • Join Our Writing Team

      July 18, 2024
      WriteForUs.png
    • Insights About a Rare Transmissible Form of Alzheimer's Disease

      February 9, 2024
      shutterstock_2417738561_PeopleImages.com_Yuri A.png
    • How to Fulfill the DEA's One Time, 8-Hour Training Requirement for Registered Practitioners

      May 24, 2024
      DEA_Checkbox.png

    About

    • About Us
    • CME Center
    • FAQ
    • Contact Us

    Shop Online

    • Newsletters
    • Multimedia Subscriptions
    • Books
    • eBooks
    • ABPN Self-Assessment Courses

    Newsletters

    • The Carlat Psychiatry Report
    • The Carlat Child Psychiatry Report
    • The Carlat Addiction Treatment Report
    • The Carlat Hospital Psychiatry Report
    • The Carlat Geriatric Psychiatry Report
    • The Carlat Psychotherapy Report

    Contact

    carlat@thecarlatreport.com

    866-348-9279

    PO Box 626, Newburyport MA 01950

    Follow Us

    Please see our Terms and Conditions, Privacy Policy, Subscription Agreement, Use of Cookies, and Hardware/Software Requirements to view our website.

    © 2025 Carlat Publishing, LLC and Affiliates, All Rights Reserved.