Use of Antipsychotics and Breastfeeding

Background: Post partum psychosis, mainly first episodes and relapses of either bipolar or schizophrenic disorders, entail severe risks for both mother and infant during postpartum, including suicide and infanticide. Although antipsychotics are now generally considered as a first line treatment for these disorders, there are no randomized controlled trials (RCTs) examining their efficacy during postpartum and there are only sparse data about their safety during breastfeeding. Methods: After a brief recall of the main indications of antipsychotics during post-partum we examined the risks and benefits of breastfeeding in that context. We reviewed the question by performing an electronic search from 1957 to January 2009. This procedure yielded a total of 28 papers reporting 18 single case reports and 13 small samples case series. Results: No adverse effect has been reported with Haloperidol, Risperidone and Quetiapine when prescribed alone and there are no published reports for Aripiprazole or Ziprasidone. One case of drowsiness and lethargy has been reported with Chlorpromazine, an infant developing agranulocytosis with Clozapine and four adverse events in case of infants exposed to Olanzapine. Mild developmental delay was noted with Clozapine alone and with a combination of Quetiapine and Paroxetine and a combination of Haloperidol and Chlorpromazine. Conclusion: Few adverse effects have been reported for first and second generation of antipsychotic drugs during lactation but only sparse data have been gathered. Meanwhile, taking into account some precautions that we summarize in proposed guidelines, it seems to be no reason in most cases to prevent a mother using antipsychotics from breastfeeding, if she wishes to do so.