Which antidepressants may we prescribe during breastfeeding?

Authors

  • Amaury Cantilino Professor adjunto, Departamento de Neuropsiquiatria, Universidade Federal de Pernambuco (UFPE), Recife, PE. Diretor, Programa de Saúde Mental da Mulher, UFPE, Recife, PE.
  • Joel Rennó Jr. Diretor, Programa de Saúde Mental da Mulher (Pro-Mulher), Instituto de Psiquiatria, Hospital das Clínicas da Universidade de São Paulo (HC-USP), São Paulo, SP.
  • Hewdy Lobo Ribeiro Psiquiatra, Pro-Mulher, Instituto de Psiquiatria, HC-USP, São Paulo, SP.
  • Jerônimo de A. Mendes Ribeiro Especialista em Psiquiatria pela ABP. Pesquisador
  • Gislene Valadares Membro fundadora, Serviço de Saúde Mental da Mulher do Hospital das Clínicas da Universidade Federal de Minas Gerais, Seção de Saúde Mental da Mulher da World Psychiatric Association e International Association of Women’s Mental Health.
  • Renan Rocha Coordenador, Serviço de Saúde Mental da Mulher, Clínicas Integradas, Universidade do Extremo Sul Catarinense, Criciúma, SC.
  • Antônio Geraldo da Silva Diretor Científico, Programa de Atualização em Psiquiatria (PROPSIQ), Sistema de Educação Continuada a Distância (SECAD).

DOI:

https://doi.org/10.25118/2763-9037.2015.v5.178

Keywords:

Postpartum depression, antidepressants, actation, breastfeeding

Abstract

Untreated maternal depression is associated with serious morbidity for the mother, the infant, and the family. The condition has significant negative effects on the mother’s ability to interact appropriately with her child. There are concerns regarding pharmacological treatment during this period because of the infant’s exposure to medication through breast milk. This article advocates that, when antidepressant treatment is indicated for postpartum depression, women should generally not be advised to stop breastfeeding. With regardto the specific antidepressant chosen for each case, paroxetine and sertraline should be considered first. Even though some concern exists with regard to fluoxetine, citalopram, and venlafaxine, because of their high concentrations in human milk, clinicians should consider that, if the mother has been effectively treated with one of these drugs during pregnancy, it is usually acceptable that treatment with the same drug should be maintained (rather than switching to another drug), even among breastfeeding mothers.

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References

Wisner KL, Sit DK, McShea MC, Rizzo DM, Zoretich RA, Hughes CL, et al. Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression fi ndings. JAMA Psychiatry. 2013;70:490-8.

Moretti M. Breastfeeding and the use of antidepressants. J Popul Ther Clin Pharmacol. 2012;19:e387-90.

Sachs HC; Committee On Drugs. The transferof drugs and therapeutics into human breast milk: an update on selected topics. Pediatrics. 2013;132:e796-809.

Hale TW. Maternal medications during breastfeeding. Clin Obstet Gynecol. 2004;47:696-711.

Berle JO, Spigset O. Antidepressant use during breastfeeding. Curr Womens Health Rev. 2011;7:28-34.

Kristensen JH, Ilett KF, Hackett LP, Yapp P, Paech M, Begg EJ. Distribution and excretion of fl uoxetine and norfl uoxetine in human milk. Br J Clin Pharmacol. 1999;48:521-7.

Moretti ME. Psychotropic drugs in lactation – Motherisk Update 2008. Can J Clin Pharmacol. 2009;16:e49-57.

Newport DJ, Ritchie JC, Knight BT, Glover BA, Zach EB, Stowe ZN. Venlafaxine in human breast milk and nursing infant plasma: determination of exposure. J Clin Psychiatry. 2009;70:1304-10.

Chad L, Pupco A, Bozzo P, Koren G. Update on antidepressant use during breastfeeding. Can Fam Physician. 2013;59:633-4.

Kearns GL, Abdel-Rahman SM, Alander SW, Blowey DL, Leeder JS, Kauffman RE. Developmental pharmacology – drug disposition, action, and therapy in infants and children. N Engl J Med. 2003;349:1157-67.

Gentile S. Use of contemporary antidepressants during breast-feeding: a proposal for specifi c safety index. Drug Saf. 2007;30:107-21.

Dugoua JJ, Mills E, Perri D, Koren G. Safety and effi cacy of St. John’s wort (hypericum) during pregnancy and lactation. Can J Clin Pharmacol. 2006;13:e268-76.

Kim DR, Epperson CN, Weiss AR, Wisner KL. Pharmacotherapy of postpartum depression: an update. Expert Opin Pharmacother. 2014;15:1223-34.

Myles N, Newall H, Ward H, Large M. Systematic meta-analysis of individual selective serotonin reuptake inhibitor medications and congenital malformations. Aust N Z J Psychiatry. 2013;47:1002-12.

Berle JØ, Steen VM, Aamo TO, Breilid H, Zahlsen K, Spigset O. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome p450 genotypes. J Clin Psychiatry. 2004;65:1228-34.

Published

2015-02-27

How to Cite

1.
Cantilino A, Rennó Jr. J, Ribeiro HL, Ribeiro J de AM, Valadares G, Rocha R, Silva AG da. Which antidepressants may we prescribe during breastfeeding?. Debates em Psiquiatria [Internet]. 2015 Feb. 27 [cited 2024 Dec. 22];5(1):18-21. Available from: https://revistardp.org.br/revista/article/view/178

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