Breastfeeding and medication: antidepressants

Antidepressants belong to the most frequently prescribed medications n pregnant and lactating women. Many mothers and their physicians fear the use of medications for pshychiatric disorders during lactation for fear of damaging the child via breastmilk. Mothers tend to not have themselves treated and their doctors to treat them and discourage continuation of breastfeeding. Both options are unnecessary and unwanted. However little research has been performed considering the exact working of antidepressants and breastfeeding , there are reviews on recorded negative complications and monoloques on the pharmakinetics of several antidepressants. Gentille started making an index based upon recordings of adverse effects and came to a preliminary list of four preferential medications. Two of those, ‘’sertraline and paroxetine should be considered as first-line medications in women who need to start antidepressant treatment during the postpartum period and wish to continue breastfeeding. The utilisation of fluoxetine and citalopram seems conversely to be associated with a relatively higher risk of adverse events (with a low degree of severity, however)’’ (Gentille, 2007). The review of Kendall and Hale starts with explaining and emphasizing the health risks for both mother and child of not treating depression and of depriving both of breastfeeding. Based on the data on transmission into milk and reports on unwanted effects they, too, conclude that sertraline and paroxetine are the preferred medications during lactation. Especially in very young children fluoxetine is not first choice, but certainly not contra-indicated either.
Kendall-Tackett K, Hale TW: Review: The Use of Antidepressants in Pregnant and Breastfeeding Women: A Review of Recent Studies J Hum Lact May 2010 26: 187-195
Gentile S: Use of Contemporary Antidepressants during Breastfeeding: A Proposal for a Specific Safety Index. Drug Safety, 2007, 30(2):107-121(15)