|: J Clin Psychiatry 2000 Feb;61(2):79-90
Mood stabilizers during breastfeeding: a review.
Chaudron LH, Jefferson JW.
William S. Middleton Memorial Veterans Affairs Hospital and the University
of Wisconsin Medical School, USA.
BACKGROUND: The postpartum period is an exceptionally high-risk time for
recurrence of depression, mania, or psychosis for women with bipolar disorder.
Puerperal prophylaxis with mood stabilizers decreases this risk. To allow
patients and clinicians to make informed decisions about mood-stabilizer
use during breastfeeding, there is a need for a critical review and analysis
of the data. DATA SOURCES: A search of MEDLINE (1966-1998) and the Lithium
Database, Madison Institute of Medicine, was conducted to obtain articles
about lithium, valproate, carbamazepine, gabapentin, or lamotrigine use
during lactation. Search terms used were pregnancy, teratogenesis, breastfeeding,
lactation, breast milk levels and lithium, anticonvulsants, mood stabilizers.
No other search restrictions were used. Unpublished data on gabapentin
and lamotrigine were provided by the manufacturers. RESULTS: The search
revealed 11 cases of lithium use during breastfeeding, 8 of which reported
infant serum levels. Two cases reported symptoms consistent with lithium
toxicity in the infants. Thirty-nine cases of valproate use during breastfeeding
were found, 8 of which reported infant serum levels. There was 1 report
of thrombocytopenia and anemia in an infant. Fifty cases of carbamazepine
use during breastfeeding were found, 10 of which reported infant serum
levels. Two infants experienced hepatic dysfunction. One unpublished study
of gabapentin in breast milk was found. Three reports of lamotrigine use
during breastfeeding were found. DISCUSSION: Available information remains
limited to uncontrolled studies and case reports. Carbamazepine and valproate,
but not lithium, have generally been considered compatible with breastfeeding.
The overall paucity of data, data confounded by polypharmacy and infant
age differences, and adverse reactions reported with all established mood
stabilizers dictate a reassessment of these recommendations. We propose
that a woman's historical response to medication and the clinical circumstances
be the primary considerations when choosing a mood stabilizer during breastfeeding,
rather than strict adherence to categorical assignments.