SYMPTOMATIC MANAGEMENT OF LACTATION FAILURE IN POSTPARTUM BIPOLAR PATIENTS ON ARIPIPRAZOLE

Bipolar disorder is a complex psychiatric condition that often requires continuous treatment, even during pregnancy. However, managing bipolar disorder in the perinatal period has unique challenges, particularly when balancing the safety of the fetus with the mental stability of the mother. Long-acting injectable (LAI) antipsychotics like aripiprazole are increasingly used during pregnancy for mood stabilization due to their lower teratogenic risk. Yet, aripiprazoles partial dopamine agonist activity can suppress prolactin levels, leading to lactation failure in the postpartum period. This case report describes a 26-year-old woman with bipolar disorder who remained stable throughout her pregnancy on LAI aripiprazole, but developed primary lactation failure following delivery. Laboratory tests confirmed low prolactin levels. By reducing the aripiprazole dose and adding a low dose of risperidone, an antipsychotic known to increase prolactin, her milk production returned without compromising her psychiatric stability. This case underscores the importance of a balanced approach in treating postpartum women with bipolar disorder. It highlights the need for proactive counseling about the potential lactation related side effects of prolactin-lowering antipsychotics, offers a stepwise strategy that begins with non-pharmacologic interventions and escalates to tailored medication adjustments as needed. Ultimately, this report emphasizes that lactation support and mood stabilization are not mutually exclusive and can be successfully achieved with thoughtful, individualized care.