Breastfeeding and Antidepressants – 4 Important Facts

Some new mothers worry about any problems associated with breastfeeding and antidepressants. It’s definitely a common concern, considering postnatal depression (PND) affects more than 1 in 7 new mums every year in Australia.

Left untreated, it can significantly impact a mother and child’s relationship.

Fortunately, PND is a treatable illness, and various treatment options exist. The most common methods for treating PND include cognitive behaviour therapy, antidepressants or a combination of both.

Other complementary and alternative medicine treatments for PND include omega-3 fatty acids, St. John’s Wort, exercise, massage, acupuncture and Napro therapy, which uses bioidentical progesterone.

There are many factors which can impact upon which treatment option(s) a mother with PND chooses. When it comes to breastfeeding mothers deciding whether to use antidepressants to treat PND, there are many factors to consider, such as the risks of untreated PND, risks of the medication to both the mother and baby, and the risks of not breastfeeding.

If antidepressants are going to be used, it’s important for mothers to be guided by their doctor.

Breastfeeding and Antidepressants

Here are 4 important facts about antidepressants and breastfeeding:

#1: Some Antidepressants Appear In Low Concentrations In Breastmilk

A baby receiving a dose (via breastmilk) of less than 10% of the maternal weight-adjusted dose is generally considered safe. Paroxetine and sertraline are two antidepressants which reach the baby at 0.5%-3% of the maternal weight-adjusted dose. While other antidepressants (e.g. fluoxetine, venlafaxine, and citalopram) produce breastmilk levels closer to — and sometimes more than — the 10% limit.

The concentration of a medication in a baby’s blood is the most accurate measure of a baby’s exposure to the medication. However, such measurements are often not available. Up-to-date information about medication use during breastfeeding can be sourced from TOXNET lactmed.

One study analysed the results of 57 previous studies, and found the use of some antidepressants (nortriptyline, paroxetine, and sertraline) during breastfeeding produced undetectable blood levels in more than 200 babies who were tested. Meanwhile, other antidepressants (fluoxetine, citalopram, and the metabolite of venlafaxine, O-desmethylvenlafaxine) produced measurable levels in some babies, although these levels were usually low.

#2: Some Antidepressants May Cause Adverse Effects In Some Babies

While there have been some adverse effects reported to babies exposed to antidepressants through breastmilk, most of these reports come from case reports and case series (which provide low quality evidence).

Also, such adverse effects include symptoms such as irritability, reduced feeding and sleep problems. It’s possible that such non-specific effects could be attributed to factors other than the antidepressants. These effects were more often reported after a baby had been exposed to fluoxetine and citalopram.

It’s important to note that long-term neurodevelopmental effects of babies being exposed to antidepressant medication through breastmilk have not been adequately researched.

#3: Sertraline And Paroxetine Are Most Commonly Recommended

Given the above information, it’s not surprising that sertraline and paroxetine are mostly recommended over other antidepressants in the postnatal period.

#4: It’s Important To Take Individual Factors Into Account

Again, it’s important for a mother to be guided by her doctor as another antidepressant may be best depending on her individual situation. For example, if a mother has been successfully treated with a specific antidepressant during pregnancy, the same medication may be the best option for the postpartum period too. This is largely because stopping or changing to a different antidepressant during the tenuous postnatal period could be very problematic.

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When it comes to the use of antidepressant medications and breastfeeding, quality and long term research is lacking. There are obvious benefits to treating PND and risks of not breastfeeding for both the mother and her baby. Hence, if PND requires the use of antidepressants, the most effective antidepressant for that individual breastfeeding mother should be considered.

For more information about Postnatal Depression, visit PANDA (Australia) and Postpartum Support International.

Recommended Reading: You may also be interested in reading Breastfeeding And Depression – Can Weaning Help?