Are there any Class A or B antipsychotics?

Question

Bipolar I, but nursing a baby. Any suggestions? Not interested in Lithium or Depakote for many reasons.

Answer 1

I hate to tell you that most of the drugs used to treat Bipolar are terrible for babies and are passed via breast milk.

Really, I would talk with your doctor. But from my understanding, the only option if you have an episode is ECT. Or change to using formula.

As a women with Bipolar 1, I have thought about this alot. Especially when I want to get pregant. There are so few options and all of those drugs cause birth defects if used in the first trimester.

Answer 2

I happen to be reading a book called Psychotropic Drugs and Women Fast Facts by Michael Gitlin and Victoria Hendrick (who "is an associate professor of psychiatry at the UCLA Neuropsychiatric Hospital. Her research focuses on the treatment of psych disorders during pregnancy and nursing, and she has published extensively on topics related to perinatal psychiatry and women's mental health.") It was published in 2004, so it is relatively up to date, however, it is quite possible that there is newer research out there.

Here's what she has to say. The only antipsychotic that is rated B is Clozaril, (which I find shocking because it's a pretty hard-core, last resort kind of medication with all sorts of side effects and it requires frequent blood tests.) All of the other antipsychotics listed are class C. Be aware that B means - animal studies show no risk, but there are no controlled studies in humans or animal studies show adverse effects that have not been confirmed in human studies. These FDA ratings are for medication use during pregnancy, I don't see a seperate one for breastfeeding.

Little is known about the safety of antipsychotics while breastfeeding. There have been reports of no adverse effect in nursing infants with mother's taking Risperdal or Zyprexa, but there is extremely little information. Her end advice is since there is so little data on this, antipsychotics should be avoided while nursing.

If they (or any psych meds) must be used, she advises the best way to go about it (it might be worth it to get your hands on a copy of this book.)

One other interesting thing is apparently an infants ability to metabolize meds "increases from approximately 33% of adult (weight-adjusted) capacity at birth to 100% at six months of age." Therefor exposure to newborns may be riskier than for older babies.

There is something in here about the University of Rochesters Lactation Study Center - they maintain a database that provides info to doctors regarding medication use and potential risksduring breastfeeding. The number is (585-275-0088). I don't know if it would be helpful or not, but I figured I'd throw it out there.

I'm bipolar II and went through this dilemma when my son was born 11 years ago. Sadly, I'm not seeing much more information than I found then. And I looked everywhere. I asked our pediatrician, I called psychiatrists and other pediatricians for advice, I called La Leche League, I got my hands on a physician's desk reference. And still, I wasn't getting straight answers from anywhere. Ultimately, I decided that being stable was more important than continuing to nurse (my son was almost 10 months old, but I had planned to do child-led weaning which I thought would be at about 2 yrs old) and that I did not feel comfortable with how little they know about the possible risks of meds while nursing. It totally broke my heart and I had a very hard time doing it, but we successfully weaned him (he was far less upset by it than I was.) I really struggled with that decision.

When it comes down to it, being BP has forced me to rearrange a lot of my life plans. :-( It's such a hard thing to cope with sometimes.

Answer 3

Current treatments of bipolar disorder are as follows:
Lithium: Pregnancy Cat. D: not good
Depakote: Pregnancy Cat. D: not good
Zyprexa: Pregnancy Cat. D: not good
Carbamazepine: Pregnancy Cat. D: not good
Neurontin: Pregnancy Cat. C: Unknown
Lamotrigine (Lamictal): Pregnancy Cat. C: Unknown effects
Topiramate (Topamax):
ECT: electro convulsive therapy