# What meds work for bipolar disorder while breastfeeding?



## carolynrosa (Apr 11, 2005)

I am currently on Lithium and Prozac, and while I'm not worried about the Prozac, I am concerned about Lithium toxicity in my baby once I begin breastfeeding. (I'm due in Dec.)
What mood stabilizers have any of you maybe been on while breastfeeding? Are there safe alternatives to Lithium? My doc suggested Lamictal, but when I looked it up, it said that was just as bad as Lithium.
I'm scared to go unmedicated, because of the high incidence of postpartum recurrence of mania with most bipolar patients, but I really want to breastfeed!
Help, please??


----------



## nighten (Oct 18, 2005)

I was about to post something very similar to this but thought i'd do a search first and see if anyone else was in the same boat.

I'm currently on Buspar and Trazodone, very small doses, and would love to go back on Lamictal when the baby comes, but it's bad to take while BFing. I plan to go off the Buspar when the baby comes but Trazodone is reportedly safe to take while BFing. But it's more a sleep aid and very mild antidepressant. It does not stabilize mood.

Anyone know of any BPD meds that are truly safe while BFing? Not just antidepressants but mood stabilizers.

I know the original post is outdated, but I thought if I got an answer, the PP would like one too.









When I talked to my pdoc about it, she seemed hesitant -- she'll have to research, etc., and it will involve an $85 office visit to get her findings. I thougth about asking a lactation consultant maybe, but then my DH suggested I talk to the Pediatrician about it, since she has more up to date info on babies and the effects of drugs in breastmilk.

Any other BPD mamas out there who breastfeed? What meds are you on? And what do you take for anxiety episodes while BFing? Xanax? If so, do you pump and dump? I went to the BFing Pharmocology site but the main answers I need are in a book that's two years outdated so that's no help...

(For what it's worth, I also take flax seed oil and fish oil, excellent vitamins and mineral supplements, and use rescue remedy, though used to --prior to pg -- use xanax on rare occasions as needed.)

TIA! Any advice is welcome.


----------



## carrietorgc (Sep 16, 2003)

have you checked out dr thomas hale's medications and mothers milk? here is a link to his web forum, you can search in categories or by drug name. good luck!

http://neonatal.ama.ttuhsc.edu/cgi-b...s&access=guest


----------



## nighten (Oct 18, 2005)

Yes and his book is outdated and the website info on the specific drugs I need info on all are "referenced in his book" which is two years outdated.







(Your link takes you to the same place as the Pharmocology one I went to). For example, I was on Lamictal which was only approved fairly recently for BPD (it's an anti-seizure med) and here's what he says about it:

Quote:

Danell Weese
Posted on Tuesday, February 08, 2005 - 04:37 pm:

--------------------------------------------------------------------------------
Dr. Hale,
I have a pregnant woman currently taking lamictal to treat her bi-polar condition. Do you have any information on the safety of taking lamictal while breastfeeding?
Thank you.

Quote:

Tom Hale Ph.D.
Posted on Tuesday, February 08, 2005 - 04:49 pm:
--------------------------------------------------------------------------------
Danell:

Everything that I know is in my book. Page 462. Check it out. There are no other data that I know of.

Tom Hale Ph.D.

-----------------

You see that post is over a year old and he references her to a book that is two years old. I know there have been new studies performed since then and there are other meds where he says they only have ONE study to go by and I'm sure there've been more studies performed since.

I guess what I'm trying to do is avoid the $85 cost of my pdoc doing this research if there's any way I can do at least some of it myself. Does that make sense?

Thanks though for the suggestion. I appreciate it.









Surely there's someone else here who has BPD? Anyone taking meds while BFing? What are you taking?


----------



## KestrelDream (Jun 3, 2005)

Bumping & subbing! I was just diagnosed with a mood disorder. It's mild, & like bipolar 2. My psychiatrist prescribed seroquel, but it's too risky. From what I have read, Zyrex & risperdal are OK. I saw the info at this site:

http://www.e-lactancia.org/ingles/inicio.asp

Any thoughts???


----------



## mosesface (Jul 25, 2006)

hmmm...this is really interesting.
would you mind posting a reference to the search you did saying lamictal was as dangerous as lithium?

in my research i've seen that lamictal, though secreted into breast milk is safer than lithium. it's risks are the same as exposure in adults ("the rash") but no toxicity issues like with lithium.

i have bipolar I, am currently on lithium and have been hoping to find answers for breastfeeding. i was kinda hoping lamictal was going to be the answer.


----------



## 2Sweeties1Angel (Jan 30, 2006)

Risperdal is supposedly ok, but it was like eating candy for me. It did NOTHING. I ended up on Seroquel and had to wean early









While I was exclusively breastfeeding, I had no trouble at all with my moods. It was only after I had to start supplementing (supply issues) that my moods went crazy again.


----------



## thefragile7393 (Jun 21, 2005)

I always recommend motherisk.org This organization really helped me and they have the most awesome reasearch. It can take a call to Canada, but really it is the best thing I could have done, because they gave me up to date research as well as levels of excretion in milk in moms who had donated milk while taking various meds/herbs. Of course every mom is different in metabolizing but...it really really helped me.


----------



## jorie (Jun 7, 2004)

I don't know where someone ever got that lamictal is as bad as lithium! I am an epileptic and have taken lamictal for 6 or 8 years. I don't know if the dosing is different for bipolar etc than for epilepsy so that could have an effect BUT I have taken 300mg/day through two pregnancies and two nurslings (still nursing one, actually). Ds1 was actually a premie and I still nursed him on lamictal. I have seen no side effects whatsoever in either of my boys from my taking lamictal. They are both above average for height and development and very cute, I'm told







. Oh, and I see a Mayo Clinic neurologist, if that holds any sway with y'all.


----------



## Ambrose (Apr 20, 2004)

I was told lamictal was ok to take too!!! I'm on seroquel as well and was told that there just wasn't any substantial data that it was a class C and it was ultimately my choice about whether to take it. Well since I can go wicked b!tch without meds I opted to take it so I can be a better mother and wife to my family as opposed to possibly WRECKING the family. KWIM?

But I DO want to find an alternative to the seroquel as I plan on pumping my breastmilk for DS whle he's in NICU. And none of the Psychiatrists have openings until NOVEMBER!


----------



## snowbird25ca (May 8, 2005)

I have bipolar disorder and I've been on lamictal for almost 6 yrs now - it's been an absolute wonder drug for me. I was on it prior to conceiving dd, ebf her until she was 6 mos and she self weaned around 22mos when I was pregnant. This baby will also be bf.

I have Thomas Hale's 2006 edition of Medication and Mother's Milk here, and while there is still not a lot of study done on it, there haven't been any problems reported in nursing infants. If you look at your dose/day and divide it by your weight in kg, that gives you your mg/kg/day dose. Your baby will get approx 30% on a mg/kg/day basis of whatever your mg/kg/day dose is. When Lamictal was tested for safety there was testing done in infants as young as 10mos old and the doses used were 2mg to 5mg/kg. Actual therapeutic dose in children 2yrs of age and up is much higher. I put together a Word document based on the manufactuers pharmocological info and some comparison stuff about Lamictal and bf'ing, and if any of you are interested feel free to PM me your email and I'll send it off to you.









I would be infinitely more comfortable with Lamictal than Lithium. Lithium is classified as an L4 drug and Lamictal as an L3. Here's the definition of each of them:

Quote:

*L3 - Moderately Safe*
There are no controlled studies in breastfeeding women, however, the risk of untoward effects to a breastfed infant is possible; or, controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit justifies the potential risk to the infant. (_New medications that have absolutely no published data are automatically categorized in this category, regardless of how safe they may be._)

*L4 - Possibly Hazardous:*
There is positive evidence of risk to a breastfed infant or to breastmilk production, but the benefits from use in breastfeeding mothers may be acceptable despite the risk to the infant (e.g., if the drug is needed in a life threatening situation or for a seriouse disease for which safer drugs cannot be used or are ineffective.)
And just to compare the 2 from some of the info in the book:

Lithium:

Quote:

Pediatric concerns - In one study cyanosis, T-wave abnormalities, and decreased muscle tone were reported. Other studies report no side effects. Evaluate infant lithium levels along with mothers.

Quote:

A number of studies of Lithium suggest that lithium is not an absolute contraindication to breastfeeding, if the physician monitors the infant closely for elevated plasma lithium. Current studies, as well as unpublished experience, suggest that the infant's plasma levels rise to about 30-40% of the maternal level, most often without untoward effects in the infant. Recent evidence suggests that certain anticonvulsants such as carbamazepine, valproic acid, lamotrigine, and others may be effective as lithium in treating some forms of mania. Because these medications are probably safer to use in breastfeeding mothers, the clinician may wish to explore the use of these medications in certain manic breastfeeding mothers.6
Lamictal:

Quote:

Pediatric Concerns: Breast milk levels are relatively high and RID (relative infant dose,) is high as well. Reported infant plasma levels are about 30% of maternal plasma levels. However, no untoward effects have been noted in any of these studies.
These are excerpts from the 2006 edition. Hope that helps some... Like I said, I'm now in pregnancy #2 and will soon be bf'ing #2 whilst being on Lamictal and haven't had any difficulties & my dd is perfectly normal. Personally I have no hesitations about bf'ing while on lamictal, but it's a decision each mom needs to make for herself based on the info available.


----------



## KestrelDream (Jun 3, 2005)

Wow. Thanks for all the info!


----------

