Breastfeeding and Antidepressants: Risks and Benefits

May 22nd, 2012
By Dr. James Pendleton, Psychotropic News Contributor

Postpartum depression is a puzzling and serious mental illness that affects anywhere from 10% to 15% of new mothers. This same population is also at a heightened risk for generalized anxiety problems such as obsessive-compulsive disorder. The effects of these illnesses are, of course, not confined to the mother. Studies have shown that infants of chronically depressed mothers exhibit slower mental and emotional growth. For these reasons and more, identifying and treating postpartum depression is critically important for the well-being of the entire family unit. Both cognitive behavioral therapy and psychotropic medications have demonstrated success at alleviating postpartum depression and anxiety. The situation becomes more complicated, however, when the mother breastfeeds her infant.

Breastfeeding is strongly recommended by public health officials the world over. All medications taken by the mother have the potential to make their way into breast milk and into the infant’s blood stream. Norwegian researchers examined the literature on infant exposure to antidepressants via breast milk and discovered that all antidepressants pass into breast milk at detectable levels. Some of these medications are also detectable in infant plasma, while others are not. For the most part, antidepressant levels in infant plasma remained below 10% of the mother’s dosage, relative to body weight. At those levels, experts believe there can be no immediate effects. Other studies that examined possible long-term effects of antidepressants in breast milk were inconclusive, but indications are that there are no significant effects.

Studies on breastfeeding and antidepressants have revealed that certain medications could theoretically pose a greater risk to the infant than others, although the overall risks are still very small. Prozac (fluoxetine) and Celexa (citalopram) have both been measured at higher concentrations in infant plasma than any other antidepressants, with the exception of tricyclic antidepressants, which are not commonly used today anyway. Paxil (paroxetine) and Zoloft (sertraline) are barely detectable in infant plasma and have never been linked with adverse events or long-term side effects. However, Paxil has been associated with both heart irregularities and withdrawal symptoms, which might argue against its use in some instances.

For breastfeeding mothers with mood problems, dealing with the issue is always the preferable option. The benefits of both breastfeeding and getting treatment for severe depression are certainly believed to outweigh the risks associated with antidepressant medications. Attending physicians must carefully weigh those risks and benefits when selecting a treatment course. Patient history and the health of the infant will be determining factors. If, for example, the mother took antidepressants during pregnancy, then continuing them postpartum should not present an issue. In utero concentrations of antidepressants are 5 to 10 times that present in breast milk. As several studies on the topic have suggested, Paxil and Zoloft might represent the first choices for treating mood disorders in new mothers.

References

Berle, J. O., Spigset, O. (2011). Antidepressant use during breastfeeding. Current Women’s Health Reviews, 7, 28-34.
PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Paroxetine. Retrieved March 8, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001037/

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