ANTIDEPRESSANT TREATMENT DURING BREAST-FEEDING

Objective: The primary purpose of this article is to review critically the literature about use of antidepressants during lactation. Strateg ies for the clinical management of depressed breast-feeding mothers ar e also suggested. Method: The authors conducted a computerized search of MEDLINE for articles. The review includes studies in which serum le vels of drugs were obtained from nursing infants. Results: Fifteen pub lished reports were located that provided information for the followin g nine antidepressants: amitriptyline, nortriptyline, desipramine, clo mipramine doxepin, dothiepin, fluoxetine, sertraline, and bupropion. C onclusions: Amitriptyline, nortriptyline, desipramine, clomipramine, d othiepin, and sertraline were not found in quantifiable amounts in nur slings, and no adverse effects were reported. Therefore, these are the drugs of choice for breast-feeding women. Adverse effects were descri bed in some young infants whose mothers had been treated with doxepin or fluoxetine during breast-feeding. The collective serum level data s uggest that infants older than 10 weeks are at low risk for adverse ef fects of tricyclics, and there is no evidence of accumulation. Researc h needs include an expanded database of mother-baby serum levels, beha vioral assessments of infants during nursing, and longitudinal develop mental evaluation of nurslings. Prescription of an antidepressant for a breast-feeding woman is a case-specific risk-benefit decision.