Intended for healthcare professionals

Rapid response to:

Clinical Review

Bipolar disorder

BMJ 2012; 345 doi: (Published 27 December 2012) Cite this as: BMJ 2012;345:e8508

Rapid Response:

Re: Bipolar disorder

Mental health problems remain a leading cause of maternal morbidity and mortality in the UK[1], so I was pleased to see that Ian Anderson and colleagues included a section about pregnancy in their interesting article, Bipolar Disorder[2]. They are however being simplistic and misleading when they state that ‘breastfeeding is contraindicated on lithium, lamotrigine and clozapine’. They rightly say that it is ‘crucial that patients are engaged and enabled to make informed choices’ about maintenance or prophylactic treatment; this should extend to decisions about lactation. The National Institute for Health has an excellent and up to date website about drugs in breastfeeding[3], and reference to this allows the clinician to use accurate information to inform the discussion with the patient. For example, there is much experience of women breast feeding whilst taking lamotrigine and olanzipine, and lithium use and breastfeeding are not always incompatible.

The numerous maternal and neonatal benefits of breastfeeding are as valuable to a woman with bipolar disorder as to the rest of the population, and doctors caring for such woman must make sure they advise these patients effectively .

1. Centre for Maternal and Child Enquiries (CMACE). Saving Mothers’ Lives: reviewing maternal
deaths to make motherhood safer: 2006–08. The Eighth Report on Confidential Enquiries into Maternal Deaths in the United Kingdom. BJOG 2011;118(Suppl. 1):1–203.
2. BMJ2012;345:e8508

Competing interests: No competing interests

05 January 2013
Joanna C Girling
Consultant Obstetrician
West Middlesex University Hospital
Twickenham Road, Isleworth TW7 6AF