Psychotropic Medication and Breastfeeding – Yes – No – Maybe?

Yes – no – maybe? The uncertainty in answering the question to what extent breastfeeding under psychopharmacotherapy can be recommended is great and the clinical management of psychopharmacotherapy in lactating women remains a challenge. Due to sparse scientific evidence, the prescription of psychotropic drugs during breastfeeding must be re-evaluated in each individual case separately. However, the risk of decompensation of maternal mental health is an important factor exerting a negative impact on the mother-infant pair, in the worst-case scenario, even with a suicide or infanticide risk. Since neither the US Food and Drug Administration (FDA) nor the European Medicines Agency (EMA) has approved a psychotropic drug for use during the breastfeeding period, treatment is always off-label and should therefore only take place after a careful risk assessment and a comprehensive informed consent with detailed documentation. Each therapeutic decision is a case-by-case decision, considering the overall constellation, consisting of psychiatric history, current diagnosis and risk assessment for the infant, ideally with the involvement of a social support network in the environment of mother and breastfeeding child. Interdisciplinary support by psychiatrists, pediatricians, gynecologists and midwives should accompany the prescription of psychotropic drugs during the breastfeeding period under regular use of therapeutic drug monitoring (TDM).