Psychopharmacology in Pregnancy and Breastfeeding

This chapter on psychopharmacology in pregnancy and postpartum discusses the decisions women must make about taking psychiatric medications when pregnant or breastfeeding. Although mild illness during pregnancy or postpartum may respond to psychotherapy and support, medication is often necessary for more serious psychiatric illness. Untreated illness can have deleterious effects on the baby and the mother. This chapter reviews the evidence that indicates it is generally safe to use the majority of psychotropic medications during pregnancy and while breastfeeding. Although it may be ideal to breastfeed, this may become complicated for women who have a psychiatric illness. Women with postpartum disorders should first be evaluated to assess whether the demands of breastfeeding are too onerous for them. Those women who can’t or don’t wish to breastfeed should not be made to feel guilty. Mothers who are suffering but wish to breastfeed can be reassured that many psychotropic medications are safe to use during breastfeeding. They may also benefit from supplementing with formula feeding with a bottle to allow the mother to get more sleep. Mothers who require medication but are afraid to use it while breastfeeding should be educated to understand that the negative effects on the baby of being depressed or psychotic outweigh any concerns about the dangers of taking medication.