Use of psychotropic medications during lactation - practical guidelines for psychiatrists

Breastfeeding is the best way of feeding infants. It is recommended by national, European and worldwide scientific associations. The advantages of breastfeeding for both the child and the mother have been proven by research. It is widely known that most Polish women start to breastfeed immediately after delivery, however, with each month, the percentage of infants given breast milk exclusively is decreasing. One of the frequent causes of breastfeeding cessation reported by women is the necessity of pharmacotherapy. There are many controversies over the use of psychotropic medications in particular. Nowadays, based on relevant current data, medications pharmacokinetics and applicable pharmacopeia, it is possible to find a therapy that may be both efficient for the mother and safe for the child. In this review, we examine available sources of data on the use of psychotropic medications during lactation. Different groups of psychiatric medications are discussed and rated in terms of their safety during breastfeeding. The Polish Psychiatric Association recommends a course of treatment to support lactation. Both termination of therapy by the mother and interruption of breastfeeding have negative consequences for both the mother and her child. The decision to let the mother continue breastfeeding may be difficult for a psychiatrist. The problem needs to be discussed thoroughly with the patient and should be carefully documented. Cooperation with other specialists such as a pediatrician and/or a lactation consultant is also highly recommended.