Q:  Medications and Breastfeeding

I am bi polar.  I recently had twins and I was able to brestfeed them for 6 weeks, but now I am in a state of mania and the medications my doctor is suggesting would make me have to stop breastfeeding, which I don't want to do.  Do you know of any medications that I could take and continue breastfeeding?

Dear Melissa -- 
The American Academy of Pediatrics has okayed Depakote for use while breastfeeding.  Some experts think that was based on too little information and aren't quite so sure it's okay.  We know lithium is not okay, and as for the rest of the medications we usually consider, there is even less information to go on than for Depakote.  You will see Tegretol on some lists as okay; it has also been approved by the AAP but surfing around today I find more skepticism about it's safety than with Depakote.  I fear the problem here, as regards these different opinions, is just too little information to go on. 

Sometimes we use low doses of the new generation of antipsychotic medications for manic symptoms, but these too have not been tested (checked a literature search on that; e.g. see this summary).  The old generation antipsychotics like Haldol are listed as "probably okay", particularly at low doses.  

Congratulations on your new family members, and for having been able to get at least 6 weeks breastfeeding with them.  Your choice now is a difficult one.  Your doctor may have already considered all the options, and their risks and benefits; you could ask for a further discussion, and I hope you could get one.  I'm sorry not to be able to be more specific about all this.  Good luck to you and your kiddos. 

Dr. Phelps

Published August, 2001