Pregnancy/breastfeeding and psychiatric meds

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goldfish

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with the little ebm data that we have on the effects of anti depressants and anti psychotics on pregnant and breastfeeding women how do u deal with it?

do u think untreated depressed/psychotic mothers can be as much if not higer risk to their child compared to the risk of adverse effects occuring in drugs?

i guess a lot depends on the severity of illness and type of drugs used but your thoughts pls 🙂
 
This is a particular grey area because there's a lack of studies for several of the meds.
http://www.womensmentalhealth.org/topics/breastfeeding_lib.html
http://www.pregnancyanddepression.com/breastfeeding.html


Pretty much all the antidepressants & antipsychotics that have been studied to see if they pass into breast milk do so. For this reason, the clinician will have to discuss the situation with the patient & the risks & options. For several patients, especially ones with psychotic sx, the risk of danger if off medication is great.

adverse effects occuring in drugs?

Hard question to answer because there is a lack of good data on the adverse effects of the meds on a developing baby that is breastfeeding.

My own opinion--if my patient had any history of dangerous history as a result of their psychiatric illness, & the medications helped, I would strongly urge the patient to continue their meds. To do so would not only put themselves at risk but also their child. If the patient wanted to breast feed while taking meds- I would discuss with them that the meds pass into the milk & there is a lack of data to the safety of the child.

Actually one thing I just considered that I never did before is--what the heck would I do if the patient had a dangerous history due to their mental illness, was stable at the time I saw them and she tells me that she doesn't want to take her meds because she wants to breastfeed her child? There is a strong danger to the baby should her psychiatric sx re-emerge--but according to state law I couldn't commit her because she wouldn't be dangerous at that moment. I'd have to ask my attendings about that one.
 
i remember reading something not too long ago about the emergence of "milk banks", sort of a modern equivalent of wet nurses. maybe this could be an option, if the patient lived in an area that had one?
 
can you legally prevent someone from breast feeding their child?
 
As far as I know, no, unless breastfeeding the child was demonstrated to be harmful-to the point where child protective services would have to get involved.

In the case of meds passing through milk--this area is grey, murky & has several unanswered questions. I haven't seen anyone even come close to the point where the law had to get involved.
 
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