Antidepressants and breastfeeding behaviors: a systematic review

To assess whether antidepressant exposure during pregnancy or postpartum is associated with changes in breastfeeding behaviors STUDY DESIGN: Systematic review of interventional and observational studies; outcomes grouped as initiation/status at discharge, preterm/NICU contexts, duration, and nighttime feeding.

Late-pregnancy exposure was consistently associated with lower initiation and reduced breastfeeding at discharge. In settings with intensive lactation support - such as among mothers of preterm infants or in NICUs-differences between exposed and unexposed dyads were small or nonsignificant. Effects on duration were context-dependent: in countries with high baseline breastfeeding, antenatal exposure was not linked to shorter duration and sometimes coincided with less early cessation; where baseline rates were lower, exposure was associated with earlier cessation. Evidence on nighttime feeding was sparse.

When antidepressant treatment is indicated, optimizing breastfeeding requires integrated perinatal care combining psychiatric monitoring, individualized medication counseling, and proactive lactation support. Prospective studies disentangling pharmacological from contextual effects are needed.