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Antidepressant Medication Use during Breastfeeding

from LEAVEN, Vol. 34 No. 2, April - May 1998, pp. 25
by Marty O'Donnell
Park Ridge, Illinois, USA

We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time

Many Leaders have noticed an increase in the number of calls about breastfeeding and the use of antidepressant medications, particularly the tricyclic antidepressants and the selective serotonin reuptake inhibitors.

While psychotropic medications (drugs that affect the mind) have been in use for more than 30 years, little information is available on the effects of these drugs in breastfed infants. What is available is based on isolated case reports in the medical literature.

Physicians and pharmacologists have published their opinions about the use of these medications by nursing mothers. While they may disagree on the advisability of individual drugs, they do agree that the potential long-term effects of psychoactive substances on the infant's brain and nervous system are unknown.

Probably the most widely cited and most highly respected opinion is found in the 1994 American Academy of Pediatrics (AAP) drug list, The Transfer of Drugs and Other Chemicals Into Human Milk, reprinted in the 1997 edition of the BREASTFEEDING ANSWER BOOK, pages 525-38. The AAP Committee on Drugs considers all antidepressants to be "drugs whose effect on nursing infants is unknown but may be of concern."

In light of the varied opinions on antidepressant use by breastfeeding mothers, the best we can so for a mother is to share information from the literature:

  • Maternal peak serum concentration The time at which a drug is at its highest level in the mother's blood.
  • Drug half-life The amount of time it takes for the drug serum concentration to decrease by one-half. This term is used to estimate how fast a drug leaves the body.
  • Milk-to-plasma ratio (M/P ratio) The concentration of a medication in milk and in plasma. Concern is raised when a drug has an M/P ratio greater than one.

This information is available for most of the antidepressants in commonly used drug references available through your Professional Liaison Leader.

In addition, Leaders can discuss strategies for dialogue with the mother's doctor, tell her we cannot recommend alternatives and let her make her own decision (in consultation with her doctor) about a drug's use--just as we do for all medications.

It is a good idea to check several references to see if the information on a particular medication is the same. Sometimes it isn't. In that case, a mother needs to hear the information from each reference so she can make an informed choice. This can also help her understand why she may be getting different opinions from her doctors.

If a mother requests the names of alternative medications, it is the physician's responsibility to provide the names of the drugs: then we can share what we know about them. We can share a drug review with a physician who is looking for more options. Contact your Professional Liaison Leader for more information.

Betty Crase, former Director of the Center for Breastfeeding Information (CBI) at LLLI Headquarters, shared her concerns in a mailing to the PL advisors about a Leader's responsibility in regard to discussions of medications:

When a Leader is wearing her "Leader hat," her responsibility is to follow LLLI lay counseling/helping guidelines. Leaders do not give medical opinions or advice. Leaders quote verbatim from LLLI-approved sources about the specific drug of concern . Leaders do not suggest/prescribe alternative drugs on their own; this is the realm of the licensed health professional.

Please refer to the 1997 BREASTFEEDING ANSWER BOOK, pages 500-09; the LEADER'S HANDBOOK, pages 213-14; LEAVEN, Sept/Oct 1986 and May/Jun 1982. These resources outline the context in which LLL Leaders can appropriately discuss medications. This is the extent of information covered by our Leader liability insurance and the standard to which we are held accountable--no more.

Women who suffer from postpartum depression require treatment that may include self-help measures, counseling, medication, and/or hospitalization. Research has shown that counseling can be as effective as medication in some instances, thereby removing the concern of drug use during breastfeeding.

A Leader provides information and support to enable the mother to avoid weaning and separation from her baby while continuing her prescribed methods of treatment. We do this by focusing on our experience as mothers, our knowledge of breastfeeding and our willingness to listen and respect a mother's feelings while she explores her options.

Additional information on postpartum depression can be found in the BREASTFEEDING ANSWER BOOK, pages 482-86 and LEAVEN, Jun/Jul 1996, pages 35-37.

Related resources

Dunnewold, A. and Crenshaw, J. Breastfeeding and postpartum depression: is there a connection? BREASTFEEDING ABSTRACTS May 1996; vol.15, No. 4:25-26.

Hatzopoulos. F. and Albrecht. L. Antidepressant use during breastfeeding. Journal of Human Lactation 1996; 12:139-41.

Kendall-Tackett, K. and Kantor, G. Postpartum depression: a comprehensive approach for nurses. Newbury Park, CA: Sage Publications, 1994.

Pons, G., Ray, E. and Matheson, I. Excretion of psychoactive drugs into breast milk. Clinical Pharmacokinetics 1994; 27:270-289.

Stuart, S. and O'Hara, M. Treatment of postpartum depression with interpersonal psychotherapy. Archives of General Psychiatry 1995; 52:75-76.

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