Paulzen Michael, Schoretsanitis Georgios
Alexianer Krankenhaus Aachen, Alexianer Aachen GmbH, Alexianergraben 33, 52062, Aachen, Deutschland.
Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland.
Nervenarzt. 2023 Sep;94(9):801-810. doi: 10.1007/s00115-023-01526-z. Epub 2023 Jul 14.
The drug treatment of mental disorders during lactation requires special knowledge about the possible effects on the breastfed infant. The first part of this 2‑part article is devoted to the use of psychotropic drugs during pregnancy. This second part addresses the use of psychotropic drugs during breastfeeding.The uncertainty about whether maternal breastfeeding can be recommended during drug treatment is high and the clinical management of psychopharmacotherapy during breastfeeding is a major challenge. Due to sparse scientific evidence, the administration of psychotropic drugs must be evaluated individually; however, the risk of mental decompensation of the mother is a weighty factor that can have a very negative impact on the mother-child pair, in the worst case up to suicide or infanticide. Drug treatment during breastfeeding is always off-label and should therefore only be given after a careful risk assessment and comprehensive clarification. Every treatment decision is a case by case decision based on an assessment of the overall constellation. This includes the psychiatric history, the current complaints and a risk assessment for the infant, ideally with the involvement of a social support network in the environment. A multiprofessional support by psychiatrists, pediatricians, gynecologists and midwives should accompany drug treatment during breastfeeding under close monitoring.This second part of the 2‑part article provides an overview of the most frequently used drug classes during the breastfeeding period. Therapeutic drug monitoring (TDM) is a valuable tool for risk and exposure assessment during the breastfeeding period.
哺乳期精神障碍的药物治疗需要了解其对母乳喂养婴儿可能产生的影响的专业知识。这篇分两部分的文章的第一部分致力于探讨孕期使用精神药物的情况。第二部分则讨论哺乳期使用精神药物的情况。在药物治疗期间，能否建议母亲进行母乳喂养存在很大的不确定性，哺乳期精神药物治疗的临床管理是一项重大挑战。由于科学证据稀少，精神药物的使用必须进行个体化评估；然而，母亲精神失代偿的风险是一个重要因素，可能对母婴关系产生非常负面的影响，在最坏的情况下甚至导致自杀或杀婴。哺乳期的药物治疗始终属于超说明书用药，因此应在仔细的风险评估和全面的说明之后才给予。每一个治疗决定都是基于对整体情况的评估逐案做出的。这包括精神病史、当前的症状以及对婴儿的风险评估，理想情况下还应有周围社会支持网络的参与。在密切监测下，应由精神科医生、儿科医生、妇科医生和助产士提供多专业支持，伴随哺乳期的药物治疗。这篇分两部分的文章的第二部分概述了哺乳期最常用的药物类别。治疗药物监测（TDM）是哺乳期风险和暴露评估的宝贵工具。
