If a mental illness exists in the woman before pregnancy, the topic “desire for a child” should be discussed with the attending physician in good time, so that pregnancy and lactation compatibility can be taken into account when selecting the medication. Depression and anxiety disorders must also be treated during these periods.
Discontinuing an already established therapy is risky and not only harms the mother, but ultimately the baby as well, because the mother’s mental state is important for the early bond between mother and child. A well-adjusted mother should not be hastily switched.
The selective serotonin reuptake inhibitor (SSRI) sertraline is the 1st choice drug for breastfeeding, followed by citalopram. The tricyclic antidepressants amitriptyline and nortriptyline are also well suited, as they have the fewest side effects for the mother.
Criticism should be given to therapy during lactation with the following substances:
- Antidepressants
- Fluoxetine (probably safe)
- Tricyclic antidepressants
- Doxepin
- For anxiety and sleep disorders
- Benzodiazepines (anxiolytics/tranquillizers (anxiety relievers) and hypnotics (sleep aids)/sedatives (sedatives)).
Monoamine oxidase inhibitors (MAO inhibitors) should not be used.Because data are insufficient for the following agents, use of these agents is also not recommended: Bupropion, mirtazapine, nefazodone, trazodone, venlafaxine.
If the mother is averse to medication for her mental illness while breastfeeding, cognitive behavioral therapy (CBT), noninvasive brain stimulation, psychotherapy, repetitive transcranial magnetic stimulation (rTMS), and direct current therapy may be an alternative. They may be effective for mild to moderate depression as well as anxiety disorders. This must be decided on a case-by-case basis.
