MEDICATIONS FOR MOTHERS’ MINDS:

Psychopharmacology for lactating mothers

If you have worked with mothers for more than a few weeks, you have encountered a mother with mental illness.  You may not have recognized the symptoms while talking  with your patient.  Or, you may get a phone call from a mother or a medical professional asking if a certain psychiatric medication is “safe” during lactation.

Perinatal mood and anxiety disorders (PMAD) include a spectrum of common mental health disorders:  postpartum depression, perinatal panic disorder, perinatal obsessive-compulsive disorder, postpartum posttraumatic stress disorder, postpartum bipolar disorder (which can include depression, hypomania and mania,) and postpartum psychosis.

These disorders often ruin enjoyment of the postpartum experience and bonding with the baby.  Perinatal bipolar disorder and postpartum psychosis are particularly dangerous due to severe depression, and reckless or bizarre behavior that can endanger mother and baby.

Medicating the lactating mother is a careful balancing act between the health and safety of the mother and the health and safety of the baby.  But failing to medicate a mother with PMAD can lead to misery, dysfunction, poor infant outcomes and in the worst situations, injury and death.

This presentation will give an overview of the different classes of antidepressants, antianxiety medications, antipsychotics, and mood stabilizers commonly used in breastfeeding mothers.  Electroconvulsive therapy and transcranial magnetic stimulation will also be discussed as non-pharmacologic treatments.