Psychopharmacotherapy during pregnancy and breastfeeding-Part II: focus on breastfeeding Support options by using therapeutic drug monitoring

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.