- Many studies
suggest that it is safe for mothers taking lithium to breastfeed their
infants. However, more
research is needed to validate these findings
- Studies to
determine the safety of lithium in breastfed babies are few.
Therefore, better designed and larger studies are needed
in the future to fill this
gap and gain more clarity
- Lithium is the
gold standard of care and treatment of choice to treat bipolar disorder,
which affects approximately 22 million women worldwide. It is beneficial
in preventing manic episodes and psychotic symptoms post-delivery
bipolar disorder taking medications like lithium wonder if
breastfeeding while on the medication is safe for their babies. The risk-benefit balance of continuing lithium treatment in breastfeeding
women is still being debated and there are no clear answers.
Following a recent review of literature by Northwestern
University, the authors conclude that
more research is necessary to determine the safety of breastfeeding
babies whose mothers are on lithium
bipolar disorder. The review will appear in the Journal of Psychiatry
‘Studies on the safety of bipolar medications like lithium in breastfed babies have been few. Although, recent studies suggest it is safe, evidence remains insufficient and in future, better-designed studies are needed to get clear answers. Till such time the risk-benefit balance of continuing lithium should be personalized for each mother and her baby.’
For the review, the study team screened 441
studies for eligibility, reviewed 230 studies
that satisfied their eligibility criteria and selected 12 studies, that
included a total of 37 patient case studies.
Or Discontinue Lithium While Breastfeeding?
- Women typically suffer from bipolar disorder during their
reproductive years and pregnancy and post -delivery period are times when there
is a high risk of relapse or worsening of the condition can occur.
- Untreated bipolar disorder is linked to unfavorable birth
outcomes for both the mother and her baby, such as small babies, preterm birth
and increased risk of maternal death due to suicide
The risks of breastfeeding while on lithium remains largely
unclear, but the risks of stopping lithium treatment have been studied widely
and can cause worsening of the illness in the mother and affect her ability to
bond with and take care of her baby
- Also for the baby, the benefits of breast milk could outweigh
the risk of lithium exposure
Thus, the decision to continue lithium treatment for
women after delivery should be made keeping in mind the best interests of both
the mother and her baby.
"This is a highly controversial topic, and
expert recommendations vary, but the truth is it's 2019, and we still don't
have the evidence to back up any of the fears about lithium use and
said senior author Dr. Crystal Clark, assistant
professor of psychiatry and behavioral sciences and obstetrics and gynecology
at Northwestern University Feinberg School of Medicine and a practicing
Northwestern Medicine psychiatrist.
"There are few absolutes when it comes to
managing illness while breastfeeding," Clark said. "It's not one size
- More well-designed studies should be done in the
future to obtain clearer answers
- Until then the safety of continuing lithium in breastfeeding mothers and the potential
harmful effects on the baby must be reviewed on a case to case basis
The study authors also feel that the stigma attached to
mental illness perhaps makes physicians reluctant to acknowledge the importance
of drug treatment for the overall health and mental well being of mothers with
In summary, more studies are needed to establish the safety
of breast milk in babies whose mothers are taking lithium for bipolar disorder.
Clark is planning future studies to examine the amount of
lithium in breast milk and how much lithium is actually ingested by babies and
the potential effects of lithium on development during childhood. References :
- Risk-Benefit Assessment of Infant Exposure to Lithium through Breast Milk: A Systematic Review of the Literature - (https://doi.org/10.1080/09540261.2019.1586657)