Pharmacological lactation suppression with D2 receptor agonists and risk of postpartum psychosis: A systematic review.
BACKGROUND
It has been suggested that D2 receptor agonists commonly used postpartum for the physiological suppression of lactation, such as bromocriptine and cabergoline, may increase the risk of illness onset or relapse in women where there is a predisposition for or history of schizophrenia, bipolar disorder or postpartum psychosis. This is based on two lines of reasoning: current models of psychosis assume episodes are triggered by dysregulation of brain dopaminergic activity and treated by medications that universally have D2 receptor antagonist properties; and limited research suggesting these agents may be associated with psychotic episodes in vulnerable individuals outside of the postpartum period.


OBJECTIVE
The aim of this study was to examine whether D2 agonists trigger psychosis in previously well mothers, or psychotic relapse or exacerbation of symptoms in mothers with known psychotic illnesses, when used to suppress lactation during the early postpartum period.


METHODS
A systematic review of the literature was undertaken of electronic databases, including: MEDLINE, EMBASE and PsychINFO from 1950 to 2015 using keywords.


RESULTS
Eight case reports, three case series and a pharmacovigilance survey were identified.


CONCLUSIONS
Whilst D2 receptor agonists appear to increase the risk of triggering psychosis in previously well mothers and those previously diagnosed with schizophrenia, bipolar disorder and postpartum psychosis, bromocriptine appears to pose a much greater risk than cabergoline. When considering the use of pharmacological agents to suppress lactation, physicians should carefully screen patients for a history of psychosis and consider alternatives to moderate this risk.
Perinatal Mental Health, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
Martien
M
Snellen
Perinatal Mental Health, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
Josephine
J
Power
Perinatal Mental Health, Mercy Hospital for Women, Heidelberg, Victoria, Australia.
Gaynor
G
Blankley
School of Medicine, University of Notre Dame, Fremantle, Western Australia, Australia.|Fiona Stanley Hospital, Murdoch, Western Australia, Australia.|Murdoch University, Murdoch, Western Australia, Australia.
Megan
M
Galbally
D001971:Bromocriptine / Q000009:adverse effects*; D000077465:Cabergoline; D018491:Dopamine Agonists / Q000009:adverse effects*; D004873:Ergolines / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007774:Lactation / Q000187:drug effects; D011605:Psychoses, Substance-Induced / Q000209:etiology*; D017448:Receptors, Dopamine D2 / Q000819:agonists*; D012307:Risk Factors
D018491:Dopamine Agonists; D004873:Ergolines; D017448:Receptors, Dopamine D2; D001971:Bromocriptine; D000077465:Cabergoline
D2 receptor agonists; ablactation; lactation suppression; postpartum; psychosis