The use of psychotropic medications during breast-feeding

Objective: The authors reviewed the risks and benefits regarding the use of psychiatric medications during breast-feeding as they relate to the health and well-being of mothers and their infants. Strategies are discussed to l imit infant exposure to a medication while effectively treating the nursing mother. Method: A MEDLINE search of the literature since 1955 was conducted to dete rmine the use of psychotropic medications in breast-feeding women. Search i tems included each of the categories of psychopharmacologic agents as well as each of the agents in association with nursing, breast-feeding, postpart um, lactation, and breast milk. Results: No controlled studies on the safety of psychotropic medications in nursing mothers were found. Case reports and small case series for each of the different psychotropic medications serve as the basis for suggested tr eatment guidelines for the management of psychiatric illnesses in breast-fe eding women. Thus, each case needs to be considered on an individual basis, with a thoughtful analysis of the risks and benefits of nursing and exposu re of the infant to medication. The baseline clinical status of the infant should also be reviewed. Conclusions: Women are vulnerable postpartum to psychiatric disorders and f requently face the need to decide whether to take psychotropic medications while breast-feeding. Should psychiatric medication be indicated, the paren ts should be provided with the available information regarding the effects of these medications on the neonate. In this way, an informed decision can be made. When psychotropic medication is used during breast-feeding, it is strongly recommended that the infant's pediatrician be involved in monitori ng the infant.