Antidepressants and nursing
(05-24-2009, 06:18 PM)ErinIsNice Wrote: I think a friend of mine has Dr. Hale's Medications and Mothers Milk--  I'll try to get some more definite information for you.

You don't have to wait, much or all of Dr. Hale's info is on

You folks know about right?

Me and the wife look up stuff on there all the time.

Go there, on the top left there's a "Is this safe when breastfeeding" link, go there, and things are broken down by category. They pull their data from multiple places, not just Hale's, good stuff!


Here's the highlights:

Zoloft is the "best drug choice so far". It has a low, low transfer rate to breastmilk (17-173 ug/liter) in mothers taking up to 150 mg/day. In one excellent study of 11 mother/infant pairs, the zoloft was undetectable in 7 of the 11 breastfeeding infants' serum and minimal in the other infants. In two other studies of one and three mother/infant pairs respectively, zoloft was undetectable in the plasma of all 4 infants. A theoretical concern with Zoloft is that some babies may not gain weight as rapidly or as well when breastfed by moms on Zoloft; so weight gain should be monitored and dosage tweaked as necessary.

Drug Hierarchy

When choosing a medication SSRIs are generally the preferred choice for a breastfeeding mother. Side effects from SSRIs are most common in the first 3 months postpartum; so with an older baby, there is little concern. Hale's "choice hierarchy" is as follows:

    * Zoloft
    * Paxil
    * Celexa
    * Effexor
    * Prozac

His conclusion:
Finally, Dr. Hale concluded his talk by saying that breastfeeding should be supported fully and not interrupted by mom's needs for medication; and that treatment of postpartum depression can be accomplished relatively safely in breastfeeding mothers. So, in his consideration, moms should continue breastfeeding and should get drug treatment as needed for depression.

Some additional points (emphasis added is mine)
    *  The effects of an untreated depressed mom on the infant are significant and hazardous; but the marginal effects of any medication usually are less hazardous than those effects. Treating a mom with postpartum depression (PPD) is much preferable to not treating, since a baby has a better outcome generally (as measured by Bayley scores, measuring interaction skills and speech and language development) when being cared for by a non-depressed parent.
    * PPD is significantly more dangerous compared to depression outside of postpartum; PPD patients are sometimes more likely to commit suicide, and need to be treated with due haste. Waiting to wean before starting medication is not a sound option. Also, weaning in order to treat is not a good choice due to the loss of the positive effects of breastfeeding. The rate of depression in the general population in an individual's lifetime is between 3% and 17%. However, in the postpartum population depression is about 15%, and is often more severe. For example, it moves to psychosis more frequently.
    * In all studies thus far, any negative effects of medication usually occur in the first 30-60 days postpartum, so breastfeeding beyond that and taking medication is usually fine.
    * Babies exposed in utero can suffer "discontinuation syndrome" (a.k.a. withdrawal effects) but sometimes this is misdiagnosed as a reaction to the continued medications in mom's milk, when really the milk transfer rate for many of the SSRIs is negligible.

The SSRI family of antidepressants is significantly improved over older antidepressants as follows:

    * Not addictive
    * No associated buzz
    * Mild withdrawal or "discontinuation syndrome" in some patients
    * More rapid onset as compared to older tricyclics
    * Side effects generally wane over time
    * Reported 60%-70% response rate in patients.

Lastly, I recommend the AAP recommended meds they have as well (antidepressants aren't on there, but I point you to this for other meds generally)

Look for low pregnancy risk categories (A or B) if pregnant, and low lactation risk meds (L1, L2) if nursing.

edited to add Kellymom AAP med link

Messages In This Thread
Antidepressants and nursing - by Paloma - 05-24-2009, 05:06 PM
Re: Antidepressants and nursing - by ErinIsNice - 05-24-2009, 05:11 PM
Re: Antidepressants and nursing - by Historian - 05-24-2009, 05:17 PM
Re: Antidepressants and nursing - by Paloma - 05-24-2009, 05:37 PM
Re: Antidepressants and nursing - by ErinIsNice - 05-24-2009, 06:18 PM
Re: Antidepressants and nursing - by libby - 05-24-2009, 06:21 PM
Re: Antidepressants and nursing - by Iuvenalis - 05-25-2009, 03:52 AM
Re: Antidepressants and nursing - by Scipio_a - 05-25-2009, 04:53 AM
Re: Antidepressants and nursing - by SCG - 05-25-2009, 10:51 AM
Re: Antidepressants and nursing - by mom - 05-26-2009, 10:17 AM
Re: Antidepressants and nursing - by Iuvenalis - 05-27-2009, 01:43 AM
Re: Antidepressants and nursing - by mom - 05-27-2009, 12:34 PM
Re: Antidepressants and nursing - by Paloma - 05-27-2009, 01:03 PM

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