Epub 2020 Jan 30.Focus (Am Psychiatr Publ). Whether symptoms are mainly affective or mainly psychotic, these disorders are frequently treated with antipsychotic medications, which calls for an examination of the relationship between hormone replacement and antipsychotic agents at these time periods.
In one report, three breastfed infants exposed to haloperidol and chlorpromazine showed developmental regression which was not seen in infants exposed to trifluoperazine alone, suggesting that use of a single antipsychotic drug poses less of a risk to a breastfed infant. No increased risk with atypical antipsychotics has yet emerged. The newer antipsychotics are also being used increasingly to treat other psychiatric disorders such as major depression and bipolar disorder.
The use of antipsychotics in special situations, such as pregnancy and puerperium, is also discussed.Menschen mit Schizophrenie können weitere psychische Störungen aufweisen, die den Erkrankungsverlauf und den Behandlungserfolg ungünstig beeinflussen können. The available data supports the use of lithium as a possible treatment option during breastfeeding.
Data are limited, particularly for the atypical antipsychotic drugs, but there are no clear associations with specific congenital abnormalities.
Carbamazepine and valproic acid are also considered relatively safe. A thoughtful risk/benefit assessment is recommended, and ideally, such a discussion should occur in advance of delivery with the patient, her psychiatrist, and her infant’s pediatrician. 02 Sep 2020
NPS MedicineWise disclaims all liability (including for negligence) for any loss, damage or injury resulting from reliance on or use of this information. All antipsychotic drugs are sedating and have relatively long half-lives, so babies should be observed for lethargy, sedation and appropriate developmental milestones particularly if multiple antipsychotic drugs are used. 2019 Sep 10;10:1005. doi: 10.3389/fphar.2019.01005.
Theoretical concerns about a relative folate deficiency have prompted some experts to suggest that women planning pregnancy while taking olanzapine should take 5 mg folate rather than the usual 0.5 mg to try and reduce the risk of neuro developmental disabilities.Limited information shows that maternal doses of olanzapine up to 20 mg/day produce low levels in milk and undetectable levels in breastfed infants.
Oral and non-depot antipsychotics with less sedating properties and a short half-life are preferred for use during breast feeding.There is very limited information available on the use of depot antipsychotic injections during breastfeeding; the majority of available information relates to oral antipsychotics. Testosterone, stimulants, and dehydroepiandrosterone may also be effective in subsyndromal depression; however, studies on these agents in general were limited by small sample size. J Clin Psychiatry.
If the infant experiences adverse effects breastfeeding must be withheld as therapeutic levels are maintained in the mother for up to several weeks following injection.Choice of antipsychotic should be based primarily on suitability for the patient rather than safety in breastfeeding.
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