Antipsychotics and breastfeeding

Nearly 10% of all postpartum women will experience some form of psychiatric illness. The development of postpartum psychosis consisting of symptoms such as auditory hallucinations, delusions, and disorganization is greatest within the first 4 weeks after delivery. In fact, a majority of cases (54%) occur within 14 days of delivery. Due to a more favorable side-effect profile, atypical antipsychotics are generally preferred over traditional antipsychotics for the treatment of psychotic symptoms. Unfortunately, there are minimal guidelines established with regard to the use of antipsychotics during lactation. This article will review currently available data on the excretion of traditional and atypical antipsychotics into breast milk and make recommendations with regard to the use of individual agents during lactation.