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Antidepressants and Breastfeeding

Q: My doctor prescribed an antidepressant for me to treat postpartum depression, but I am breastfeeding my child.  Is this safe for the baby?

Dr. Donnica:
If you are breastfeeding or if you may be pregnant, you should always tell your doctor before any medication decisions are made.  In the case of postpartum depression and most antidepressants, you can rest assured that drug therapy is highly effective and does not necessarily require women to stop nursing. Even though antidepressant medications all get into the breast milk, it is unclear that this has any untoward effects on the baby. (You should discuss this issue with your physician for any prescription or over-the-counter medication you may take.) The most important health factor for a baby is having a healthy mother and the effective treatment of your PPD is very important.  However, your doctor should prescribe the lowest effective dose of antidepressants necessary.

It is often helpful to carefully observe the infant's normal behavior patterns before mom is treated and then to objectively compare the infant's behavior after treatment starts to see if there are any noticeable effects.

Various antidepressant medicines have been studied to varying degrees in nursing mothers and sertraline (Zoloft TM) has often been recommended as the first-line choice for nursing moms on the basis of several studies (see New England Journal of Medicine, 7/18/02).  No reports of adverse effects in breastfed infants whose mothers were treated with sertraline (Zoloft) , paroxetine (Paxil), or fluvoxamine (Luvox) have been published to date.  In infants who were breastfed by moms on fluoxetine (Prozac), colic has been reported in 3 infants, and another report indicated that these babies gained less weight. Continuous exposure to Prozac in breast milk is more likely to lead to increased blood levels of the medication in nursing babies than exposure to other drugs in the Selective Serotonin Reuptake Inhibitors class. 

Tricyclic antidepressants are not typically measurable in breastfed infants of the moms who take them, although these medicines are not generally considered as first line therapy for the treatment of depression.  Of the choices in this class of drugs, nortrityline (Pamelor) has been most well studied.

Click here for more information about depression or other mental health issues.

Created: 7/30/2002  -  Donnica Moore, M.D.

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