From Medscape today:

Is it safe to prescribe psychotropic medication to women who are
breastfeeding

A majority of the literature on psychotropics in breast milk are single case
histories on many diverse drugs, and there are significant methodologic
problems limiting the conclusions that can be drawn from many of these
reports. Because of these shortcomings, a majority of researchers and
clinicians err on the side of caution, recommending that medication be
avoided while breastfeeding when at all possible. In keeping with this,
polypharmacy is best avoided. Women who must take drugs during pregnancy
should, if possible and clinically sensible, have doses decreased at term to
minimize the amount of drug in the infant's system at delivery, with doses
increased immediately after delivery. The use of mood stabilizers,
particularly lithium, is generally not recommended because of potential
toxicity. Clozapine is the other psychotropic best avoided, for the same
reason.

With increasing data on other medications, there is less concern about the
postpartum use of low-dose minor tranquilizers and, increasingly, the SSRIs.
Given the data on the adverse effects of depression and psychosis on
mother-infant interaction and infant development, there is increased
recognition of the importance of aggressively treating maternal depression
postpartum. Whenever prescribing to a breastfeeding mother, it is essential
for the clinician to fully inform her and her partner about the lack of
data. In most situations, the medications do not seem to have long-term
effects, and any adverse effects are generally side effects rather than
toxicity, and are reversible. However, the data are sparse and rely on
naturalistic studies rather than randomized control trials; therefore, any
negative effects -- on the developing nervous system, for example -- may be
subtle.

Source: Buist A: Treating mental illness in lactating women. Medscape
Women's Health. 2001;6(2).
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Anna Swisher
Austin, TX

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