Psychopharmacology and Psychiatry Updates Postpartum Psychopharmacology: Breastfeeding and Bipolar Disorder
Dec 27, 2025
Psychiatrist Lauren Osborne, an expert in perinatal psychopharmacology, dives into the complex interplay of postpartum psychosis and bipolar disorder. She shares insights on the use of mood stabilizers, particularly lithium, in breastfeeding mothers. Osborne emphasizes that sleep disruption often influences breastfeeding choices more than drug exposure. She also outlines the relative risks of medications like lamotrigine and lithium during lactation, advocating for early lithium treatment while managing risks for both mother and infant.
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Lithium As Gold-Standard Treatment
- Postpartum psychosis is an affective illness closely related to bipolar disorder, so mood stabilization is central to treatment.
- Lithium is considered the gold-standard for both acute treatment and prophylaxis of postpartum psychosis.
Breastfeeding Risks Center On Sleep Loss
- The breastfeeding decision in bipolar disorder is driven more by sleep disruption risks than by medication exposure alone.
- Sleep loss is a potent trigger for mood episodes in postpartum bipolar patients, so feeding plans must protect maternal sleep.
Case-By-Case Breastfeeding With Lithium
- Consider breastfeeding decisions case-by-case when a mother is on lithium and involve the pediatrician for monitoring.
- Monitor infant hydration closely because dehydration raises the infant's risk for lithium toxicity.