It has been assumed that lactating women should limit the use of any medications, but there are situations in which the patient is obliged to use them. A significant change in a woman’s life and the accompanying hormone fluctuations, along with an emotional swing, can cause mental disorders in mothers who are nursing their conception. It is quite common in the postpartum period, requiring psychotropic drugs in severe situations.
There are only a few studies on the safety of psychotropic drugs during lactation, so most of the information is based on case reports and case series.
It is unlikely that patients should be made aware of the benefits of breastfeeding infants. It is recommended to exclusively breastfeed your baby for at least the first 6 months of life, and to continue feeding with other foods until 12 months of age.
More than 85% of new mothers suffer from common postpartum depression, which is temporary and is characterized by tearfulness, mood swings, irritability and anxiety. They should disappear after about two weeks and do not require additional special pharmacotherapy. Alternatively, you can help yourself in natural ways.
Postpartum depression is one of the more severe mental problems, it affects approximately 5-20% of women between 25 and 44 years of age. The symptoms are the same as for depression at any other time, and include depressed mood, insomnia, anhedonia and thoughts of suicide. The research results clearly showed that in pregnant women with moderate to severe recurrent depression who discontinued treatment during pregnancy, depression recurred in about 70% of cases compared with women who continued treatment during pregnancy, when depression returned only in about 25% of cases.
A fairly common condition in the postnatal period is postpartum panic disorder.
Untreated maternal mental illness can negatively affect the mother-child relationship. One study found that babies of mothers with untreated depression cry more often and are harder to calm down. Considering the benefits and risks of fetal drug exposure, pharmacotherapy should be carefully considered.
Psychotropic drugs and breastfeeding
It is an undeniable fact that all psychotropic drugs pass into breast milk to a greater or lesser extent due to their lipophilicity. However, this does not mean that they must pose a risk to the child. Most drugs are considered safe if the relative dose in the infant is less than 10%. All antidepressants have been found to have “unknown effects” that may be “disturbing” during breastfeeding.
The summary analysis of antidepressant drug concentrations in lactating women suggests that the use of these drugs during lactation is probably safe.
There are many groups of drugs used to treat depression, including:
Serotonin reuptake inhibitors (SSRIs)
According to many studies, the safety of the use of SSRIs is confirmed, as the transfer of these substances into breast milk is relatively small or undetectable, but individual reports have shown side effects in infants exposed to these drugs.
These therapeutic agents include fluoxetine, sertraline, citalopram, escitalopram, fluvoxamine, and paroxetine. As research shows, the highest concentration in the serum of infants was shown by drugs such as fluoxetine and cialopram. In contrast, for sertraline and paroxetine, concentrations were not detected in most cases. In conclusion, the drugs of choice for breastfeeding women should be SERTRALINE or PAROXETINE. An alternative in the case of too high risk of using psychotropic drugs may be to give up feeding.
According to the American Academy of Pediatrics, the effects of using this class of drugs are “unknown, but potentially worrying.” The side effects of nortriptyline, imipramine, desipramine, or clomipramine were not seen in most cases. However, this does not mean that they can be used freely.
Like TLPDs, their use may be questionable, but overall observations have made it clear that they have the lowest infant milk / plasma ratio than other psychotropic drugs. In addition, the milk / plasma concentrations of benzodiazepines with a short half-life, i.e. lorazepam, alprazolam and oxazepam, were tested and found to be very low and thus no adverse effects were observed.
In the course of many analyzes carried out, it was found that carbamazepine and valproic acid are the most suitable for use from the group of drugs with mood stabilizing effect. However, in some case reports, carbamazepine has been associated with hepatotoxicity in infants
In conclusion, the recommendations regarding the use of drugs during breastfeeding suggest that untreated maternal mental disorders are harmful to both the fetus and the conceived child. Therefore, specialist psychiatrists work out each case in detail, guided by the so-called Hale’s classification, which determines the safety of using a medicine for a child. It is worth remembering that in order to minimize drug exposure, the lowest effective dose is prescribed for a child to avoid the return of symptoms. According to accepted standards, doctors most often prescribe short-acting drugs. Decisions to continue breastfeeding should always be carefully considered and the risk of breastfeeding mothers using psychotropic medications explained to the patient.
- Becker M. A. et al., Leki psychotropowe a karmienie piersią, Psychiatria po Dyplomie, Tom 6, Numer 5, 2009.