Breastfeeding and Psychotropics: What You Need to Know About Medications and Milk

When you’re breastfeeding and need help with depression, anxiety, or psychosis, the question isn’t just can I take this pill? It’s will it hurt my baby? The answer isn’t yes or no—it’s nuanced, and it depends on the drug, the dose, and your unique situation. Psychotropic medications, a category of drugs that affect brain function to treat mental health conditions like depression, bipolar disorder, and schizophrenia. Also known as mental health medications, these include SSRIs, antipsychotics, mood stabilizers, and benzodiazepines—each with different levels of transfer into breast milk. The good news? Many are considered low-risk when used carefully, and stopping them can be far more dangerous than continuing them.

SSRIs, a common class of antidepressants that increase serotonin levels in the brain. Also known as serotonin reuptake inhibitors, these include sertraline, fluoxetine, and escitalopram are often the first choice for nursing mothers. Studies show sertraline, for example, passes into milk in tiny amounts, and most babies show no side effects. Fluoxetine builds up over time and may cause irritability or sleep issues in some infants, so it’s often avoided unless necessary. Antipsychotics, medications used to treat psychosis, hallucinations, and severe mood swings. Also known as neuroleptics, these include risperidone, quetiapine, and olanzapine are trickier—some have more data than others, but most are considered compatible with breastfeeding at low to moderate doses. The key is starting low and watching your baby for drowsiness, poor feeding, or jitteriness.

What about lithium? It’s a mood stabilizer with a narrow therapeutic window, and it does concentrate in breast milk. Most experts recommend avoiding it unless you have no other options—and even then, only with close monitoring of your baby’s kidney function and lithium levels. Benzodiazepines like lorazepam are short-acting and often okay for occasional use, but long-term use can make babies sleepy or weak. Never stop your meds cold turkey—sudden withdrawal can trigger relapse, which harms both you and your child more than any medication ever could.

There’s no perfect answer, but there is a smart path: talk to your doctor, track your baby’s behavior, and don’t assume all psychotropics are the same. Your mental health matters as much as your baby’s. If you’re stable, you’re better able to care for them. The goal isn’t zero exposure—it’s minimal risk with maximum benefit. Below, you’ll find real comparisons of medications, safety data, and what other moms have experienced when balancing mental health and motherhood.