References to useful information about medications in pregnancy and lactation:

A local NZ Site about Lactation and Medications - detailed and useful

Another NZ site with a number of useful links

Australian Govt. site about drugs in pregnancy

Additional comments on these references by Dr Cathy Hapgood
(Psychiatrist: Maternal Mental Health Service, Waitemata DHB, Auckland):

Breast-Feeding:
  • Never presribe Doxepin to breastfeeding women as there have been severe reactions from babies, even in a low dose (e.g. apnoea attacks occurred in a previously healthy baby 2 months old).
  • Sodium Valproate - care needed, can cause a rare fatal condition for baby.
  • All antipsychotics - tend to discourage breastfeeding on these, due to side effects e.g. sedation, but also uncertainty as to how they may affect the developing brain. Also women requiring this medication need to have a good night's sleep and the hormones elevated during breast-feeding may affect this.
  • Preferred benzodiazepine for sleep is Temazepam or short acting e.g. Lorazepam. Always express in the morning and throw away the expressed milk. Only use for a short period.
  • Neonates' livers don't start working properly until approx 10-12 weeks old so it is best if possible to avoid treatment until then. Women breast-feeding need to know this so they can decide whether they want to wean and bottle-feed.
  • To assist with weaning, chilled cabbage leaves on the breasts are very effective to treat discomfort. Safer than bromocryptine in acute post-partum psychiatric disorders. Nursing staff on maternity wards are usually expert in exactly how to use the cabbage-leaf technique to best effect.

Pregnancy:
  • Lithium is used in pregnancy, e.g. in one woman throughout her whole pregnancy due to risk of relapse if it were ceased - but usually just in the 2nd and 3rd trimester. In deciding have to weigh up the clients' illness history and discuss risks vs benefits with them.

Also note the recent information from some studies which may indicate a slightly greater risk of congenital malformations in some pregnant women taking SSRIs, esp. paroxetine. See the TGA website for further details.