Pharmacology Review

After completing this article, readers should be able to: 1. Describe the mechanism of transfer of antidepressants into human milk as well as the relative doses transferred and reported adverse effects. 2. Describe the transfer of antipsychotics into human milk. 3. Provide clinical data for choosing an appropriate antipsychotic agent for a breastfeeding mother. 4. Describe the transfer of antimanic medications into human milk. 5. Describe the choices of sedatives and their relative entry into the milk compartment. 6. Recommend the best choices of antidepressants and antipsychotics for use in breastfeeding mothers. Breastfeeding significantly reduces the risk of certain disorders (eg, necrotizing enterocolitis, diarrheal disease, neonatal sepsis) in newborns, stimulates maturity and development of the gastrointestinal tract, and has numerous advantages for brain and intelligence quotient (IQ) development. In addition, long-term benefits include a reduced incidence of many infectious diseases (upper respiratory tract infections, otitis media, infectious diarrhea) and various autoimmune syndromes, including Crohn disease and ulcerative colitis. Thus, the benefits of breastfeeding are significant, and discontinuing breastfeeding, simply to take a medication, requires strong justification. The management of depression and other mental illnesses during lactation presents a complex problem in which the possible risks to the infant from maternal medications must be weighed against the numerous proven benefits of breastfeeding. Because the incidence of psychiatric illness is much higher in the postnatal period than at any other period in a woman’s life, many women today who are being treated for mental illness are among those who ultimately wish to breastfeed, particularly due to the strong emphasis in perinatal classes and women’s support groups. At least 10% to 20% of postpartum mothers suffer from depression, and 10% to 16% of pregnant women fulfill the American Psychiatric Association Diagnostic and Statistical Manual , edition 4 (DSM-IV) diagnostic criteria for major depression. Using these numbers, it is estimated …