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Antidepressant treatment during breast-feeding
K L Wisner1, J M Perel, R L Findling
1Mood Disorders Program, Case Western Reserve, University School of Medicine, Cleveland, OH 44106, USA.
The American Journal of Psychiatry
|September 1, 1996
Summary
Certain antidepressants like sertraline are safe for breast-feeding mothers, showing no quantifiable amounts in infants. However, caution is advised with doxepin and fluoxetine due to potential infant adverse effects.
Area of Science:
- Pharmacology
- Neonatal Medicine
- Psychiatry
Background:
- Maternal depression is a significant concern.
- Breast-feeding is encouraged for infant health.
- Antidepressant use during lactation requires careful consideration of risks and benefits.
Purpose of the Study:
- To critically review literature on antidepressant use during lactation.
- To suggest clinical management strategies for depressed, breast-feeding mothers.
Main Methods:
- Computerized MEDLINE search for relevant articles.
- Inclusion of studies measuring drug serum levels in nursing infants.
Main Results:
- Fifteen reports analyzed nine antidepressants: amitriptyline, nortriptyline, desipramine, clomipramine, doxepin, dothiepin, fluoxetine, sertraline, and bupropion.
- Amitriptyline, nortriptyline, desipramine, clomipramine, dothiepin, and sertraline were undetectable in infants, with no reported adverse effects.
- Doxepin and fluoxetine were associated with adverse effects in some young infants.
Conclusions:
- Amitriptyline, nortriptyline, desipramine, clomipramine, dothiepin, and sertraline are recommended as first-line antidepressants for breast-feeding women.
- Infants over 10 weeks old appear to be at low risk for tricyclic antidepressant adverse effects.
- Individualized risk-benefit assessment is crucial for prescribing antidepressants to lactating mothers.