Psychotropic medication and breast-feeding

Abstract

The physical and psychological benefits of breastfeeding for the mother and the infant are numerous and range from improved and stronger bonding to better immunological protection. Breast-fed infants have fewer episodes of middle-ear and urinary tract infections and lower mortality rates than bottle-fed babies (Nulman et al, 2003). Breast milk contains nucleotides and enzymes that promote digestion and absorption of nutrients. Breast-feeding has been associated with better cognitive functioning and better performance on IQ measures at age 7-8 years (Fergusson et al, 1982;Lucas et al, 1992).For the mother, breast-feeding causes oxytocin and prolactin release, precipitates postnatal uterine involution and suppresses ovulatory cycles.Breast-feeding has been successfully promoted in recent decades and a significantly large group of women now believe in its benefits and enquire about the possibilities of breast-feeding even when they are on psychotropic medication. It is the duty of the prescribing psychiatrist to guide the mother, the carers, the community mental health team, the general practitioner (GP), the obstetricians and the paediatricians through the intricacies of this complex area of psychopharmacology, in which there is an increasing interest but only scant research, few case studies and limited publications. Pharmacokinetics of psychotropics in breast milkResearchers need information on four factors in order to understand problems related to breastfeeding by mothers taking psychotropic medication: the prescribed dose; the level of the drug in the mother's blood plasma; the level in the breast milk; and the levels in the infant's serum. The amount of drug excreted in the milk is important in evaluating any drug-induced toxicity in the infant.The medication's diffusion across membranes, its molecular weight and its lipophilicity each play an important role in determining the amount that enters the breast milk (Nulman et al, 2003).The milk that comes out towards the end of a feed (hind milk) has a higher concentration of lipids than the thinner foremilk. Consequently, hind milk will contain a greater concentration of any lipid-soluble drug. Colostrum, produced only during the first few days after birth, has a higher protein level and will therefore contain a greater concentration of proteinbound drugs.To evaluate infant exposure to a drug the concentration of the medication or its metabolite are measured simultaneously in the mother's plasma and breast milk. A milk/plasma ratio greater than 1 Psychotropic medication and breast-feeding Dora KohenAbstract Adverse effects of psychotropic medication on breast-fed infants have not been studied in controlled and systematic research. Existing information comes from small case series and single case reports. These limited data confirm that psychotropics are excreted into breast milk and that the infant is exposed to them. In recent decades sufficient data have accumulated to allow psychiatrists to prescribe tricyclic antidepressants, selective serotonin reuptake in...

Prototypes of Newly Conceived Inorganic and Biological Sensors for Health and Environmental Applications

“…Schimmell et al . [29,30] studied drug plasma levels in a breast-fed infant whose mother had taken clomipramine during pregnancy and continued after giving birth. They found that levels were high following delivery but decreased gradually and were at the lowest detectable concentration at 35 days, even though breast-feeding continued.…”

Pharmacological management of psychiatric disorders in pregnancy complicated by diabetics

“…[48] Anti-psychotics Typical anti-psychotics have been reported to be safe during breast feeding. [49] Their levels in maternal milk and infant serum have been found to be low. Also, these have not been associated with any adverse effects in the infants.…”

“…Although there are no reports on adverse effects due to the use of olanzapine and risperidone by breast-feeding mothers, it has been recommended to consider the riskbenefit analysis before their prescription. [49] Reports have suggested that clozapine accumulates in breast milk and its use is contraindicated during breast feeding. [50] There is limited information on amisulpride and quetiapine to make any favorable recommendations for their use.…”

“…Use of valproate and carbamazepine has been reported to be compatible with breast feeding. [49] However, transient hepatic toxicity such as hyperbilirubinemia and high concentrations of gamma glutamyl transferase has been reported in neonates exposed to carbamazepine during breast-feeding.…”

Major Depressive Disorder

“…The exception to this is fluoxetine, which appears to have a dose-related risk for detectable levels in infant sera. [86] …”