Antidepressant Use During Breastfeeding

Department of Psychiatry, Haukeland University Hospital, P.O. Box 23 Sandviken, N-5812 Bergen, Norway.
Current Women s Health Reviews 02/2011; 7(1):28-34. DOI: 10.2174/157340411794474784
Source: PubMed


The treatment of breastfeeding mothers with depression raises several dilemmas, including the possible risk of drug exposure through breast milk for the infant. This article provides background information and presents practical advice and recommendations for the clinician dealing with the treatment of depression and related disorders in the postpartum period.

An electronic search for relevant articles was performed. As the use of tricyclic antidepressants has considerably decreased during the last decade and no new information on breastfeeding has emerged for the tricyclics in this period, this review exclusively focuses on the newer, non-tricyclic compounds.

Most newer antidepressants produce very low or undetectable plasma concentrations in nursing infants. The highest infant plasma levels have been reported for fluoxetine, citalopram and venlafaxine. Suspected adverse effects have been reported in a few infants, particularly for fluoxetine and citalopram.

Infant exposure of antidepressants through breast milk is generally low to very low. We consider that when antidepressant treatment is indicated in women with postpartum depression, they should not be advised to discontinue breastfeeding. Paroxetine and sertraline are most likely suitable first-line agents. Although some concern has been expressed for fluoxetine, citalopram and venlafaxine, we nevertheless consider that if the mother has been treated with one of these drugs during pregnancy, breast-feeding could also be allowed during continued treatment with these drugs in the postpartum period. However, an individual risk-benefit assessment should always be performed.

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Available from: Jan Øystein Berle, May 16, 2014
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    • "Clinical reports have shown that newborns exposed to SSRI during gestation have an increased risk for developing adverse effects, such as low birth weight, lower gestational age, neuro-behavioral disturbances and reduced cardiac frequency (Oberlander et al., 2009). In addition, newborns exposed to fluoxetine have detectable plasma drug concentration levels of up to 80% (Berle and Spigset, 2011). However, few studies have evaluated the possible alterations that may occur in the gnathic bones when exposed to the drug during formation and development. "
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    ABSTRACT: To verify whether the use of fluoxetine during gestation and lactation interferes in mandibular bone formation in rats. Twenty-four Wistar rat pups were used and distributed into four groups: CG - control of gestation; CL - control of gestation and lactation; FG - treated with fluoxetine during gestation and FL - treated with fluoxetine during gestation and lactation. At 25 days of life, after anesthesia, perfusion and decapitation, the mandibles were removed. Radiographic, histologic, histometric and polarizing microscopy analyses were performed. Statistical analysis was used considering a level of 5% significance. The FL group compared with its control (CL) was shown to differ statistically from the other groups as regards histometry and radiopacity, revealing a reduction in the inferior cortical thickness, reduction in number of osteocytes, with consequent reduction in radiographic bone density. There was also reduction in the number of osteoblasts in FG. The long-term use of fluoxetine via oral route by pregnant and lactating rats modifies the mandibular bone mass. Published by Elsevier GmbH.
    Full-text · Article · Jun 2015 · Acta histochemica
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    • "The treatment of breastfeeding mothers with depression raises several dilemmas, including the possible risk of drug exposure through breast milk for the infant against the disadvantage of not receiving mother's milk. [26]. As for SSRIs, evidence is available showing that detectable drug levels have been found in breast milk for all antidepressant studies. "
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    ABSTRACT: Lots has been written on use of SSRI during pregnancy and possible short and long term negative outcomes on neonates. the literature so far has described a various field of peripartum illness related to SSRI exposure during foetal life, such as increased incidence of low birth weight, respiratory distress, persistent pulmonary hypertension, poor feeding, and neurobehavioural disease. We know that different degrees of outcomes are possible, and not all the newborns exposed to SSRIs during pregnancy definitely will develop a negative outcome. So far, still little is known about the possible etiologic mechanism that could not only explain the adverse neonatal effects but also the degree of clinical involvement and presentation in the early period after birth. Pharmacogenetics and moreover pharmacogenomics, the study of specific genetic variations and their effect on drug response, are not widespread. This review describes possible relationship between SSRIs pharmacogenetics and different neonatal outcomes and summarizes the current pharmacogenetic inquiries in relation to maternal-foetal environment.
    Full-text · Article · Jan 2014
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    • "Side effects in infants are found mostly with fluoxetine and citalopram.83 The tricyclic doxepine is also not recommended.83,84 Particular caution should be used when the baby is premature, of low birth weight, or currently ill, as all these conditions are linked to a decrease in metabolic capacity. "
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    ABSTRACT: Postpartum depression (PPD) is common, occurring in 10%-15% of women. Due to concerns about teratogenicity of medications in the suckling infant, the treatment of PPD has often been restricted to psychotherapy. We review here the biological underpinnings to PPD, suggesting a powerful role for the tryptophan catabolites, indoleamine 2,3-dixoygenase, serotonin, and autoimmunity in mediating the consequences of immuno-inflammation and oxidative and nitrosative stress. It is suggested that the increased inflammatory potential, the decreases in endogenous anti-inflammatory compounds together with decreased omega-3 poly-unsaturated fatty acids, in the postnatal period cause an inflammatory environment. The latter may result in the utilization of peripheral inflammatory products, especially kynurenine, in driving the central processes producing postnatal depression. The pharmacological treatment of PPD is placed in this context, and recommendations for more refined and safer treatments are made, including the better utilization of the antidepressant, and the anti-inflammatory and antioxidant effects of melatonin.
    Full-text · Article · Feb 2013 · Neuropsychiatric Disease and Treatment
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