Austin M P, Mitchell P B
Department of Liaison Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia.
Aust N Z J Psychiatry. 1998 Dec;32(6):778-84. doi: 10.3109/00048679809073866.
The postnatal period is a time of increased onset and relapse of mental illness. It poses a clinical dilemma, as many mothers requiring medication acutely or prophylactically will also choose to breast feed. The present paper first reviews the safety of psychotropes in breast-fed infants and the usefulness of prophylaxis for women at risk of postpartum affective relapse and, second, provides guidelines in the use of psychotropic drugs in breast-feeding women.
A Medline review was conducted reviewing all papers published during the period 1993-1998 (and their associated bibliographies) on the use of psychotropes in breast-feeding women and the prophylactic usefulness of medications in women at risk of affective postpartum relapse.
Findings are based on case reports and small, mostly uncontrolled studies. Both tricyclic antidepressants (TCA) and specific serotonin re-uptake inhibitors (SSRIs) appear to be relatively safe in breast feeding. Antidepressants commenced in the early postpartum period may reduce depressive relapse. While prophylactic lithium appears to significantly reduce relapse of affective psychosis in the puerperium, there have been no studies of the anticonvulsants in the puerperium. Finally, high dose antipsychotics should be avoided, as they may be associated with long-term adverse sequelae in the infant.
On the basis of current knowledge, the use of SSRIs, TCA, carbamazepine, sodium valproate and short-acting benzodiazepines in breast feeding is relatively safe. If lithium is to be used, close collaboration with a paediatrician is essential. The long-term risks of antipsychotics, especially at high doses, remain to be clarified. Before a decision can be made, the risk-benefit ratio must be clearly outlined and discussed with the mother and her partner.
产后是精神疾病发病和复发增加的时期。这带来了一个临床难题，因为许多急需药物治疗或预防性用药的母亲也会选择母乳喂养。本文首先回顾了精神药物在母乳喂养婴儿中的安全性以及对有产后情感复发风险的女性进行预防的有效性，其次提供了母乳喂养女性使用精神药物的指导原则。
对1993年至1998年期间发表的所有关于母乳喂养女性使用精神药物以及药物对有产后情感复发风险女性的预防有效性的论文（及其相关参考文献）进行了医学文献数据库检索。
研究结果基于病例报告和大多为非对照的小型研究。三环类抗抑郁药（TCA）和选择性5-羟色胺再摄取抑制剂（SSRI）在母乳喂养中似乎相对安全。产后早期开始使用抗抑郁药可能会减少抑郁复发。虽然预防性使用锂似乎能显著降低产褥期情感性精神病的复发率，但尚未有关于产褥期抗惊厥药物的研究。最后，应避免使用高剂量抗精神病药物，因为它们可能与婴儿的长期不良后果有关。
根据目前的知识，母乳喂养中使用SSRI、TCA、卡马西平、丙戊酸钠和短效苯二氮䓬类药物相对安全。如果要使用锂，与儿科医生密切合作至关重要。抗精神病药物的长期风险，尤其是高剂量时的风险，仍有待阐明。在做出决定之前，必须明确概述风险效益比并与母亲及其伴侣进行讨论。
