Antidepressants of choice during Lactation.

Q: The postnatal period represents a critical phase for mothers with history of major depression. Which of the following antidepressant have better neonatal safety profile and is preferred over other antidepressants during breastfeeding period?

 


 

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PREFERRED ANTIDEPRESSANT IN BREAST FEEDING:

  • Sertraline

  • Paroxetine

  • Nortriptyline

 

Source:

  • TOXNET Toxicology Date Network.
  • Arch Womens Ment Health. 2015 Apr;18(2):139-46.
  • Other studies are discussed below.

 


SERTRALINE

  • Preferred antidepressant during breastfeeding. 

  • Levels in breastmilk: LOW. 

  • Levels in Infant: Minimal/no level detected. Note that desmethylsertraline (active metabolite) is often weakly detected in low levels. 

 


PAROXETINE

  • Preferred antidepressant during breastfeeding. 

  • Levels in breastmilk: LOW.

  • Levels in Infant: Minimal/no level detected.

  • NOTE: Mothers taking paroxetine during third trimester have reported occasional side effects. 

 


STUDY#1

The available data on antidepressant levels in nursing infants were analyzed in order to calculate average infant drug levels and determine what factors influence plasma drug levels in breast-feeding infants of mothers treated with antidepressants.

  • Nortriptyline, paroxetine, and sertraline may be preferred choices in breast-feeding women.

  • Minimizing the maternal dose may be helpful with citalopram.

  • This data do not support monitoring breast milk levels in individual patients. 

 

Source: Am J Psychiatry. 2004 Jun;161(6):1066-78.

 


STUDY#2

  • When antidepressant treatment is indicated in women with postpartum depression, they should not be advised to discontinue breastfeeding. 

  • Paroxetine and sertraline are most likely suitable first-line agents. 

  • The highest infant plasma levels have been reported for fluoxetine, citalopram and venlafaxine.  

    Note that if mother has been treated with one of these drugs during pregnancy, breast-feeding could also be allowed during continued treatment with these drugs in the postpartum period. However, an individual risk-benefit assessment should always be performed.

  • Suspected adverse effects have been reported in a few infants, particularly for fluoxetine and citalopram.

  • Duloxetine and bupropion have undetectable levels in infant.

  • Escitalopram, reboxetine and mirtazapine detected at extremely low concentrations in infant plasma.

 

Source: Curr Womens Health Rev. 2011 Feb; 7(1): 28–34.

 


STUDY#3:

  • Sertraline and paroxetine show a better neonatal safety profile during breastfeeding as compared with other SRIs.

 

Source: Hum Psychopharmacol. 2015 Jan;30(1):4-20.


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Dr. Harvinder Singh, M.D. (Admin)


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