Mass General Hospital

Harvard Medical School

Breastfeeding and Psychiatric Medication

General Principles:

Llewellyn A, Stowe Z. Psychotropic medications in lactation. J Clin Psychiatry 59 (suppl 2):41-52, 1998.

Antidepressants:

Birnbaum CS, Cohen LS, Bailey JW, Grush LR, Robertson LM, Stowe ZN. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics 104(1):e11., 1999.

Burt VK, Suri R, Altshuler L, Stowe Z, Hendrick VC, Muntean E. The use of psychotropic medications during breast-feeding. Am J Psychiatry 158(7):1001-1009, 2001.

Epperson N, Czarkowski KA, Ward-O’Brien D, Weiss E, Gueorguieva R, Jatlow P, Anderson GM. Maternal sertraline treatment and serotonin transport in breast-feeding mother-infant pairs. Am J Psychiatry 158(10):1631-1637, 2001.

Hendrick V, Fukuchi A, Altshuler L, Widawski M, Wertheimer A, Brunhuber MV. Use of sertraline, paroxetine and fluvoxamine by nursing women. Br J Psychiatry 179:163-166, 2001.

Hendrick V, Stowe ZN, Altshuler LL, Mintz J, Hwang S, Hostetter A, Suri R, Leight K, Fukuchi A. Fluoxetine and norfluoxetine concentrations in nursing infants and breast milk. Biol Psychiatry 50(10):775-782, 2001.

Llewellyn A, Stowe Z. Psychotropic medications in lactation. J Clin Psychiatry 59 (suppl 2):41-52, 1998.

Misri S, Kim J, Riggs KW, Kostaras X. Paroxetine levels in postpartum depressed women, breast milk, and infant serum. J Clin Psychiatry 61(11):828-832, 2000.

Newport DJ, Hostetter A, Arnold A, Stowe ZN: The treatment of postpartum depression: Minimizing infant exposures. J Clin Psychiatry 63(Suppl 7):31-44, 2002.

Ragan K, Stowe Z, Newport D. Use of antidepressants and mood stabilizers in breast-feeding women., in Mood and anxiety disorders during pregnancy and postpartum., vol 24. Edited by Cohen L, Nonacs RN. Washington, DC, 2005, American Psychiatric Publishing.

Stowe ZN, Cohen LS, Hostetter A, Ritchie JC, Owens MJ, Nemeroff CB. Paroxetine in human breast milk and nursing infants. Am J Psychiatry 157(2):185-189, 2000.

Stowe Z, Hostetter AL, Owens MJ, Ritchie JC, Sternberg K, Cohen LS, Nemeroff CB. The pharmacokinetics of sertraline excretion into human breast milk: Determinants of infant serum concentrations. J Clin Psychiatry 64(1):73-80, 2003.

Suri R, Stowe Z, Hendrick V, Hostetter A, Widawski M, Altshuler LL. Estimates of nursing infant daily dose of fluoxetine through breastmilk. Biol Psych 52(5): 446-451, 2002.

Anti-Anxiety Agents

Birnbaum CS, Cohen LS, Bailey JW, Grush LR, Robertson LM, Stowe ZN. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics 104(1):e11., 1999.

Burt VK, Suri R, Altshuler L, Stowe Z, Hendrick VC, Muntean E. The use of psychotropic medications during breast-feeding. Am J Psychiatry 158(7):1001-1009, 2001.

Fisher J, Edgren B, Mammel M. Neonatal apnea associated with maternal clonazepam therapy. Obstet Gynacol 66:34-35s, 1985.

Wesson DR CS, Harkey M, Smith DE. Diazepam and desmethyldiazepam in breast milk. J Psychoactive Drugs 17:55-56, 1985.

Mood Stabilizers:

Frey B S, Schubiger G, Musy JP. Transient cholestatic hepatitis in a neonate associated with carbamazepine exposure during pregnancy and breast-feeding. Eur J Pediatr. 150(2):136-138, 1990.

Goldsmith D, Wagstaff A, Ibbotson T, Perry CM. Spotlight on lamotrigine in bipolar disorder. CNS Drugs 18(1):63-67, 2004.

Liporace J, Kao A, D’Abreu A. Concerns regarding lamotrigine and breast-feeding. Epilepsy Behav 5(1):102-105, 2004.

Merlob P MN. Transient hepatic dysfunction in an infant of an epileptic mother treated with carbamazepine during pregnancy and breastfeeding. Ann Pharmacother. 12:1563-1565, 1992.

Ohman I, Vitols S, Tomson T. Lamotrigine in pregnancy: Pharmacokinetics during delivery, in the neonate, and during lactation. Epilepsia 41(6):709-713, 2000.

Oles KS, Gal P: Stevens-johnson syndrome associated with anticonvulsant therapy in a neonate. Clin Pharm. 1982 Nov-Dec;1(6):565-7.

Schou M, Amdisen A: Lithium and pregnancy iii: Lithium ingestion by children breastfed by women on lithium treatment. Br Med J 2:138, 1973.

Schou M. Lithium treatment during pregnancy, delivery, and lactation: An update. J Clin Psychiatry 51:410-413, 1990.

Tunnessen WW, Hertz CG: Toxic effects of lithium in newborn infants: A commentary. J Pediatr 81:804-807, 1972.

Viguera A, Newport DJ, Ritchie J, Stowe Z, Whitfield T, Mogielnicki J, Baldessarini RJ, Zurick A, Cohen LS. Lithium in breast milk and nursing infants: Clinical implications. Am J Psychiatry 164(2):342-345, 2007.

Anti-Psychotic Agents:

Aichhorn W, Stuppaeck C, Whitworth AB. Risperidone and breast-feeding. J Psychopharmacol 2005;19:211-3.

Barnas C, Bergant A, Hummer M, Saria A, Fleischhacker WW. Clozapine concentrations in maternal and fetal plasma, amniotic fluid, and breast milk. Am J Psychiatry 151:945, 1994.

Croke S, Buist A, Hackett LP, Ilett KF, Norman TR, Burrows GD. Olanzapine excretion in human breast milk: estimation of infant exposure. Int J Neuropsychopharmacol 2002;5:243-7.

Gardiner SJ, Kristensen JH, Begg EJ, Hackett LP, Wilson DA, Ilett KF, Kohan R, Rampono J. Transfer of olanzapine into breast milk, calculation of infant drug dose, and effect on breast-fed infants. Am J Psychiatry. 2003 Aug;160(8):1428-31.

Gentile S. Clinical utilization of atypical antipsychotics in pregnancy and lactation. Ann Pharmacother. 38(7-8):1265-71, 2004.

Goodwin G, Young AH. Using guidelines in real clinical situations: clozapine and breast feeding in bipolar disorder.[comment]. Journal of Psychopharmacology 2005; 19(3):317-8.

Lee A GE, Dunn E, Ito S. Excretion of quetiapine in breast milk. Am J Psychiatry 2004;161:1715-6.

Misri S, Corral M, Wardrop AA, Kendrick K: Quetiapine augmentation in lactation: a series of case reports. J Clin Psychopharmacol 2006;26:508-11.

Ratnayake T, Libretto SE: No complications with risperidone treatment before and throughout pregnancy and during the nursing period. J Clin Psychiatry 63(1):76-77, 2002.