BREASTFEEDING AND PSYCHIATRIC MEDICATIONS: How Safe Are They?


There are a quite amount of women who are in need of pharmacological treatment while nursing. However, a strong concern is raised regarding the safety of psychotropic drug use in women who choose to breastfeed while taking these medications. While many women with postpartum illness delay treatment because they are worried that the medications they take may harm the nursing infant, the accumulated data indicates that the risk of adverse events in the nursing infant is low.

Lets Examine The General Principles

Did you know that there are many women who require psychiatric medications want to breastfeed? Lets face it, there are many benefits to breastfeeding, I can understand why some of these women want to breastfeed their little star. Given the many benefits of breastfeeding, some women taking psychiatric medications may wish to nurse their infants. When making this decision, several variables must be considered. These include the known and unknown risks of medication exposure for the baby via breast milk, the effects of untreated illness in the mother, and the benefits of and maternal preferences for breastfeeding. There are established health benefits of breastfeeding for babies and mothers.

Efforts have been made to quantify the amount of psychotropic medications and their metabolites in the breast milk of nursing mothers. In order to more accurately measure the infant’s exposure to medication, serum drug levels in the infant have also been assessed. From the available data, it appears that all medications, including antidepressants, antipsychotic agents, mood stabilizers, and benzodiazepines, are secreted into the breast milk. However, concentrations of these agents in breast milk vary considerably. The amount of medication to which an infant is exposed depends on several factors- pertaining to the specific medication, the maternal dosage of medication, the frequency of dosing and infant feedings, and the rate of maternal drug metabolism.

How Does Psychiatric Medication Affects Gestation?

The decision to breastfeed while taking medications is more complicated when a baby is premature or has medical complications. The nursing infant’s chances of experiencing toxicity are dependent not only on the amount of medication ingested but also on how well any ingested medication is metabolized. Most psychotropic medications are metabolized by the liver.

During the first few weeks of a full-term infant’s life, there is a lower capacity for hepatic drug metabolism, which is about one-third to one-fifth of the adult capacity. Over the next few months, the capacity for hepatic metabolism increases significantly and, by about 2 to 3 months of age, it surpasses that of adults. In premature infants or in infants with signs of compromised hepatic metabolism (e.g., hyperbilirubinemia), breastfeeding typically is deferred because these infants are less able to metabolize drugs and may be more likely to experience adverse events.

Antidepressants: What Are The Risks?

Antidepressants in general are considered to be relatively safe for use during breastfeeding when clinically warranted, and SSRIs in particular are one of the best studied classes of medications during breastfeeding. Excellent and thorough reviews on the topic of antidepressants and breastfeeding have been published (Burt 2001Weissman 2004). In the most rigorous studies, nursing women have repeatedly provided breast milk samples and infant blood samples in order for investigators to quantify medication exposure to the infant.

Data have accumulated regarding the use of various antidepressant medications during breastfeeding. Available data on the use of tricyclic antidepressants (TCAs), fluoxetine, paroxetine, and sertraline during breastfeeding have been encouraging and suggest that the amounts of drug to which the nursing infant is exposed is low and that significant complications related to neonatal exposure to antidepressants in breast milk appear to be rare. Typically very low or non-detectable levels of drug have been detected in the infant serum, and one recent report indicates that exposure to medication in breast milk does not result in clinically significant blockade of serotonin (5-HT) reuptake in infants.

Although less information is available on other antidepressants, serious adverse events related to exposure to these medications have not been reported. There have been a small number of case reports of adverse events in infants exposed to antidepressants in breast milk, including jitteriness, irritability, excessive crying, sleep disturbance, and feeding problems. In many cases it has not been possible to establish a causal link between these events and exposure to drug.

Many clinicians and their patients ask which antidepressant is the “safest” for breastfeeding. It is somewhat misleading to say that certain medications are “safer” than others. All medications taken by the mother are secreted into the breast milk, and there is no evidence to suggest that certain antidepressants pose significant risks to the nursing infant.

In terms of selecting an appropriate antidepressant, one should try to choose an antidepressant for which there are data to support its safety during breastfeeding (i.e., sertraline, paroxetine, fluoxetine, tricyclic antidepressants). However, some situations may warrant the use of antidepressants with less available safety data. For example, if a woman has responded to a particular antidepressant in the past, it would be reasonable to consider using that antidepressant again. If she has been taking an antidepressant during the course of her pregnancy and has been doing well, it would be prudent to continue with that same antidepressant after delivery, as switching to another antidepressant may put her at increased risk for relapse.

We do not regularly measure drug levels in the breastfeeding mother or baby; however, there may be certain situations where information on exposure to drug in the child may help make decisions regarding treatment. If there is a significant change in the child’s behavior (e.g., irritability, sedation, feeding problems, or sleep disturbance), an infant serum drug level may be obtained. If levels are high, breastfeeding may be suspended. Similarly if the mother is taking a particularly high dosage of medication, it may be helpful to measure drug levels in the infant to determine the degree of exposure.

How Will Anti-Anxiety Agents Affect Me Breastfeeding?

Given the prevalence of anxiety symptoms during the postpartum period, anxiolytic agents are often used in this setting. Data regarding the use of benzodiazepines have been limited; however, the available data suggest that amounts of medication to which the nursing infant is exposed are low. Case reports of sedation, poor feeding, and respiratory distress in nursing infants have been published; however, the data, when pooled, suggest a relatively low incidence of adverse events in infants exposed to benzodiazepines in the breast milk.

What About Mood Stabilizers?

For women with bipolar disorder, breastfeeding may pose more significant challenges. First, on-demand breastfeeding may significantly disrupt the mother’s sleep and thus may increase her vulnerability to relapse during the acute postpartum period. Second, there have been reports of toxicity in nursing infants related to exposure to various mood stabilizers, including lithium and carbamazepine, in breast milk.

What About Lithium? Is it safe?

Lithium is excreted at relatively high levels in the mother’s milk, and infant serum levels are about one-third to one-half of the mother’s serum levels. Reported signs of toxicity in nursing infants have included cyanosis, hypotonia, and hypothermia. Although breastfeeding typically is avoided in women taking lithium, some women may choose to use lithium while nursing. In this setting, the lowest possible effective dosage should be used and both maternal and infant serum lithium levels should be followed. In collaboration with the pediatrician, the child should be monitored closely for signs of lithium toxicity, and lithium levels, thyroid stimulating hormone (TSH), blood urea nitrogen (BUN), and creatinine should be monitored every 6-8 weeks while the child is nursing.

Several recent studies have suggested that lamotrigine reaches infants through breast milk in variable doses, with infant serum levels ranging from 20%-50% of the mother’s serum concentrations. In addition, maternal serum levels of lamotrigine increase significantly after delivery, which may contribute to the high levels found in nursing infants. None of these studies have reported any adverse events in breastfeeding newborns. To read more on the safety of lamotrigine versus lithium, please reference this past blog.

STEVEN JOHNSON’S SYNDROME

One worry shared by clinicians and new mothers is the risk for Stevens-Johnson syndrome (SJS). This is a severe, potentially life-threatening rash, most commonly resulting from a hypersensitivity reaction to a medication, which occurs in about 0.1% of bipolar patients treated with lamotrigine. Thus far, there have been no reports of SJS in infants associated with exposure to lamotrigine. In fact, it appears that cases of drug-induced SJS are extremely rare in newborns. Despite the variable levels of medication found in infants in studies to date, none of these studies have reported any adverse events in the breastfeeding newborns. More research is required to assess the safety of lamotrigine in nursing infants, and decisions regarding the use of this drug in breastfeeding women involves a careful consideration of the risks and benefits of using this medication.

Although the American Academy of Pediatrics has deemed both carbamazepine (Tegretol) and valproic acid (Depakote) to be appropriate for use in breastfeeding mothers, few studies have assessed the impact of these agents on infant well-being. Both of these mood stabilizers have been associated in adults with abnormalities in liver function and fatal hepatotoxicity. Hepatic dysfunction secondary to carbamazepine exposure in breast milk has been reported several times. Most concerning is that the risk for hepatotoxicity appears to be greatest in children younger than 2 years of age; thus, nursing infants exposed to these agents may be particularly vulnerable to serious adverse events. In those women who choose to use valproic acid or carbamazepine while nursing, routine monitoring of drug levels and liver function tests in the infant is recommended. In this setting, ongoing collaboration with the child’s pediatrician is crucial.

Antipsychotic Agents

Information regarding the use of antipsychotic drugs is limited and is particularly lacking for the newer atypical agents. While the use of chlorpromazine has been associated with adverse events including sedation and developmental delay, adverse events appear to be rare when medium- or high-potency agents are used.

Less data, however, is available on the atypical antipsychotic agents. Data on clozapine suggest that it may be concentrated in the breast milk; however, there are no data on infant serum levels, making it difficult to interpret the relevance of this finding. Given the severity of adverse events associated with clozapine exposure in adults (i.e., decreased white blood cell count), the use of this medication should be reserved for those with treatment-refractory illness, and monitoring of white blood cell counts in the nursing infant is mandatory.

There is very limited data on the use of other atypical antipsychotic agents during lactation; however, limited data available on olanzapine, risperidone, and quetiapine suggest that the excretion of these medications in breast milk is low and that adverse effects appear to be rare. Monitoring of the infant is encouraged, as there has been one report of an infant who had sedation on a higher dose of olanzapine, which resolved after the mother’s dose was halved to 5mg/day. To date, there have been no reports on the use of the antipsychotic medications, ziprasidone (Geodon) and aripiprazole (Abilify) while breastfeeding.

Treatment Guidelines

Consultations regarding the safety of psychiatric medications in breastfeeding women should include a discussion of the known benefits of breastfeeding to mother and infant and the possibility that exposure to medications in the breast milk may occur. Although routine assay of infant serum drug levels was recommended in earlier treatment guidelines, this procedure is probably not warranted; in most instances low or non-detectable infant serum drug levels will be evident and serious adverse side effects are rarely reported. This testing is indicated, however, if neonatal toxicity related to drug exposure is suspected. Infant serum monitoring is also indicated when the mother is nursing while taking lithium, valproic acid, carbamazepine, or clozapine.

We have varying amounts of study pertaining to individual medications, with SSRIs being among the best studied medications in breastfeeding. Also, data that is available informs most specifically on the short-term safety of these medications, and long term systematic data are unavailable. Therefore, in each individual case, the known and unknown risks of exposure must be balanced with the risks of untreated maternal illness in the mother and her desire to breastfeed.

For the latest information on breastfeeding and psychiatric medication, please visit our blog.

How do I get an appointment?

Despite the high rate of postpartum depression seen in women after childbirth, the illness is frequently not treated because of women’s wish to breastfeed. Clinical consultation is offered to women who may benefit from use of medication while breastfeeding, taking into account all available information regarding the safety of this practice during lactation. Consultations regarding treatment options can be scheduled by calling our intake coordinator at 617-724-7792.

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Here is a great video on use of antidepressants while breastfeeding for you to watch. Enjoy! as you learn

BOTOX AND BREASTFEEDING :Top Rated Research


Hello Mamas. What a topic we have today – Botox. A very popular topic indeed. I am so happy to share with you, current information about this drug as it relates to breastfeeding.

Every mother wants to maintain her youthful appearance while breastfeeding. Some women can have an attractive Mothers may be keen to maintain their youthful skin even while breastfeeding. To some, Botox may be an attractive treatment, as it can provide immediate relief to wrinkles and creases on the face. Did you know that in the US there are over 7 million users of Botox since 2017? The biggest issue with Botox is how safe is it?

What Is Botox?

There are many legitimate advantages and concerns with Botox. For one, it contains the neuromodulator onabotulinum toxin type A, a drug that is produced from Clostridium botulinum, which can stop muscle contractions by blocking the transmission of acetylcholine to muscles.

This mechanism of action is effective for various muscle spasm-based conditions, including cosmetic indications like glabellar lines in between the eyebrows, forehead lines, and canthal lines drawn by the orbicularis oculi muscle at the corner of the eye. The constant muscle movement may deepen these folds. A simple Botox injection can help to relax these muscles and smooth the skin’s complexion.

Botox in breastfeeding mothers: No Evidence Of Its Effects

As of now, there is no significant data regarding the presence of Botox in human milk, how it affects the milk production process, and how or if it has any effect on the breastfed child. Because of this lack data, many healthcare professionals do not recommend Botox treatments for nursing women.

Some researchers have pointed out that the large size of Botox particles may inhibit its infiltration into the systematic circulation of the body. Additionally, Tthe lack of evidence of Botox’s effects on lactation can also be attributed to the low dose of Botox that has been administered into mothers in previous cases.

On the other hand, Botox is still considered a suitable medication for non-cosmetic purposes such as cervical dystonia. Botox should be prescribed under a doctor’s discretion and only if it is determined that the potential positive outcomes from a Botox treatment outweighs its risks. Certain off-label uses of Botox can be applied if it is medically necessary.

Some mothers undergoing Botox treatments had concerns about Botox’s possible adverse effects on them and they resorted to a technique dubbed “pump and dump.” This is a method where women would express the milk and throw it out in the hope that harmful substances can be expelled along the way. However, this method does not affect the metabolization of Botox; it only affects the supply of breast milk. Plus, there is also no clear indication of botulinum toxin being metabolized in breast milk.

It is always better for a nursing mother to consult with their doctor about their suitability for receiving Botox.

Alternatives to Botox for breastfeeding mothers

If Botox is not recommended for nursing mothers, what other methods should they seek out?

Hyaluronic acid fillers such as Restylane or Juvederm may be suitable treatment choices because these substances’ high compatibility with the human body. Unfortunately, these too are under heavy usage restrictions with breastfeeding mothers because of a lack of data on their safety for that demographic.

What about mechanical aesthetic treatments, such as microdermabrasion and microneedling? Or even traditional procedures like acupuncture?

These methods are also dubious, although some physicians may be more lenient in terms of using them as compared to Botox. Postpartum patients who are still breastfeeding may have very sensitive skin that does not respond well to these methods. However, the use of shallow needles and less chemicals/substances like topical anesthetics may make these skin rejuvenating techniques more appropriate.

Overall, most doctors would suggest that patients finish breastfeeding before seeking out Botox treatments. If patients are still desperate for treatment, there are a few home remedies and practices that they can follow, including the following:

  • Using sunscreens or sunblock when they are out;
  • Staying hydrated by drinking water;
  • Eating healthy foods, such as leafy greens, nuts, fatty fish, and avocados to repair damaged skin;
  • Using hydrating and rejuvenating topical skincare products that are rich in hyaluronic acid and glycerin;
  • Increasing the use of vitamins A, C, and E; keratin; and omega-3 supplements.

Before taking this medicine…….

You should not be treated with Botox if you are allergic to botulinum toxin, or if you have:

  • an infection in the area where the medicine will be injected; or
  • (for overactive bladder and incontinence) if you have a current bladder infection or if you are unable to urinate and you do not routinely use a catheter.

To make sure Botox is safe for you, tell your doctor if you have ever had:

  • other botulinum toxin injections such as Dysport or Myobloc (especially in the last 4 months);
  • amyotrophic lateral sclerosis (ALS, or “Lou Gehrig’s disease“);
  • myasthenia gravis;
  • Lambert-Eaton syndrome;
  • a side effect after prior use of botulinum toxin;
  • a breathing disorder such as asthma or emphysema;
  • problems with swallowing;
  • facial muscle weakness (droopy eyelids, weak forehead, trouble raising your eyebrows);
  • a change in the normal appearance of your face;
  • bleeding problems; or
  • surgery (especially on your face).

The botulinum toxin contained in Botox can spread to other body areas beyond where it was injected. This can cause serious life-threatening side effects.

Call your doctor at once if you have a hoarse voice, drooping eyelids, vision problems, severe eye irritation, severe muscle weakness, loss of bladder control, or trouble breathing, talking, or swallowing.

Bottom Line

Due to the lack of convincing evidence on its safety, most doctors would steer away from prescribing Botox to their nursing patients. Although there have been no explicit claims that Botox can pass through the breast milk or affect its production, there are no significant results or studies that have said otherwise.

Ultimately, patients should inform their doctors if they are breastfeeding to avoid any misunderstandings or complications with treatments. Your doctor will determine whether Botox is suitable at the time.

Note on articles: These articles are not endorsed by DoctorMedica nor reviewed for medical accuracy. Similarly, views and opinions expressed are those of the author only. Articles are meant for informational purposes only. Ask your doctor for professional medical advice.
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Thank you for stopping by . I sure hope you learned something. It is not a good decision to breastfeed it you plan to get this type of treatment. You must by all means make the choice to maintain the safety factor for your little star. If you have any comments or questions feel free to comment below. I wish you a safe, happy, and healthy breastfeeding journey.

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Here is a great video about botox and breastfeeding. Enjoy! as you learn