Format

Send to

Choose Destination
Eur Neuropsychopharmacol. 2016 Oct;26(10):1562-78. doi: 10.1016/j.euroneuro.2016.08.008. Epub 2016 Aug 24.

Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder.

Author information

1
Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
2
Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, CIBERSAM, Barcelona, Catalonia, Spain.
3
Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Italy.
4
Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; UOC di Psichiatria Universitaria, Dipartimento di Medicina di base, Neuroscienze e Organi di senso, University 'Aldo Moro', Bari, Italy.
5
Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Policlinico Umberto I, "Clinica delle Malattie nervose e Mentali, La sapienza Universitá di Roma, Roma, Italy.
6
Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; CHU Clermont-Ferrand, Department of Psychiatry, EA7280, University of Auvergne, Clermont-Ferrand, France.
7
BIOARABA Health Research Institute. OSI Araba. University Hospital. University of the Basque Country, CIBERSAM, Vitoria, Spain.
8
Psychiatry Service, University Hospital Ramón y Cajal, University of Alcalá, CIBERSAM, IRYCIS, Carretera Colmenar km. 9.1, 28034 Madrid, Spain.
9
Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona, Spain.
10
University Hospital La Paz, IdiPAZ, CIBERSAM, Madrid, Spain.
11
Psychiatry Service, San Cecilio University Hospital, Granada, Spain.
12
Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
13
Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Electronic address: evieta@clinic.ub.es.

Abstract

Breast milk is considered the best source of nutrients and provides much better protection than immune modified milk. However, the postpartum period is a phase of increased risk for all women to experience psychiatric symptoms and recurrences or new episodes of bipolar disorder (BD), especially in those who have discontinued treatment. This is a systematic review of the risks and benefits of mood stabilizers and antipsychotics during breastfeeding as they relate to the health and well-being of mothers and their infants. Evidence-based treatment advice for women with BD during lactation is also provided. This systematic review has been conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We included studies examining the exposure and the effects of antipsychotics and mood stabilizers used to treat BD on infants during breastfeeding clearly reporting the estimated amount of drug or effects on infants. The final selection included 56 studies. The available data supports the use of lithium as a possible treatment option during breastfeeding. Carbamazepine and valproic acid are also considered relatively safe. Lamotrigine can be used but at the lowest doses and considered for individual cases. Among the antipsychotics, quetiapine and olanzapine should be considered as first-line treatment options. Risperidone may be compatible with breastfeeding under medical supervision. Clozapine and amisulpiride are currently contraindicated. Long-term outcome studies evaluating the infant׳s health and psychosocial and cognitive functioning are needed.

KEYWORDS:

Antipsychotics; Bipolar disorder; Breastfeeding; Lactation; Mood stabilizers

PMID:
27568278
DOI:
10.1016/j.euroneuro.2016.08.008
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center