title: Mood stabilizers and antipsychotics during breastfeeding: Focus on bipolar disorder.
abstract: Breast milk is considered the best source of nutrients and provides much better protection than immune modified milk. However, the postpartum period is a phase of increased risk for all women to experience psychiatric symptoms and recurrences or new episodes of bipolar disorder (BD), especially in those who have discontinued treatment. This is a systematic review of the risks and benefits of mood stabilizers and antipsychotics during breastfeeding as they relate to the health and well-being of mothers and their infants. Evidence-based treatment advice for women with BD during lactation is also provided. This systematic review has been conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. We included studies examining the exposure and the effects of antipsychotics and mood stabilizers used to treat BD on infants during breastfeeding clearly reporting the estimated amount of drug or effects on infants. The final selection included 56 studies. The available data supports the use of lithium as a possible treatment option during breastfeeding. Carbamazepine and valproic acid are also considered relatively safe. Lamotrigine can be used but at the lowest doses and considered for individual cases. Among the antipsychotics, quetiapine and olanzapine should be considered as first-line treatment options. Risperidone may be compatible with breastfeeding under medical supervision. Clozapine and amisulpiride are currently contraindicated. Long-term outcome studies evaluating the infant׳s health and psychosocial and cognitive functioning are needed.
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors: Isabella
authors: I
authors: Pacchiarotti
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, CIBERSAM, Barcelona, Catalonia, Spain.
authors: Jordi
authors: J
authors: León-Caballero
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors: Andrea
authors: A
authors: Murru
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Division of Psychiatry, Clinical Psychology and Rehabilitation, Department of Medicine, Santa Maria della Misericordia Hospital, University of Perugia, Italy.
authors: Norma
authors: N
authors: Verdolini
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; UOC di Psichiatria Universitaria, Dipartimento di Medicina di base, Neuroscienze e Organi di senso, University 'Aldo Moro', Bari, Italy.
authors: Maria Antonietta
authors: MA
authors: Furio
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; Policlinico Umberto I, "Clinica delle Malattie nervose e Mentali, La sapienza Universitá di Roma, Roma, Italy.
authors: Corinna
authors: C
authors: Pancheri
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors: Marc
authors: M
authors: Valentí
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain; CHU Clermont-Ferrand, Department of Psychiatry, EA7280, University of Auvergne, Clermont-Ferrand, France.
authors: Ludovic
authors: L
authors: Samalin
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors: Eva Solé
authors: ES
authors: Roigé
authors: BIOARABA Health Research Institute. OSI Araba. University Hospital. University of the Basque Country, CIBERSAM, Vitoria, Spain.
authors: Ana
authors: A
authors: González-Pinto
authors: Psychiatry Service, University Hospital Ramón y Cajal, University of Alcalá, CIBERSAM, IRYCIS, Carretera Colmenar km. 9.1, 28034 Madrid, Spain.
authors: Jose Manuel
authors: JM
authors: Montes
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors: Antonio
authors: A
authors: Benabarre
authors: Department of Psychiatry, University Hospital of Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), CIBERSAM, Barcelona, Spain.
authors: Jose Manuel
authors: JM
authors: Crespo
authors: University Hospital La Paz, IdiPAZ, CIBERSAM, Madrid, Spain.
authors: Consuelo
authors: C
authors: de Dios Perrino
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain.
authors: Jose Manuel
authors: JM
authors: Goikolea
authors: Psychiatry Service, San Cecilio University Hospital, Granada, Spain.
authors: Luis
authors: L
authors: Gutiérrez-Rojas
authors: Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceara, Fortaleza, CE, Brazil.
authors: André F
authors: AF
authors: Carvalho
authors: Hospital Clinic, Institute of Neuroscience, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Catalonia, Spain. Electronic address: evieta@clinic.ub.es.
authors: Eduard
authors: E
authors: Vieta
mesh_terms: D000328:Adult; D018692:Antimanic Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D014150:Antipsychotic Agents / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000150:complications / Q000188:drug therapy*; D001942:Breast Feeding; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008895:Milk, Human / Q000737:chemistry / Q000378:metabolism; D049590:Postpartum Period
chemical_list: D018692:Antimanic Agents; D014150:Antipsychotic Agents
keywords: Antipsychotics; Bipolar disorder; Breastfeeding; Lactation; Mood stabilizers