Breastfeeding and Antidepressants
To Nurse or Not While Treating Postpartum Depression with Medication
Aug 15, 2009
Postpartum depression occurs in one-fifth of postnatal women. Most of these women require antidepressant therapy to manage their condition. For those mothers who opt to breastfeed during the drug therapy some medications may have adverse effects caused to the nursing infants.
Causes of Postpartum Depression
Postpartum depression is characterized by changes in moods, anxiety, insomnia, irritability among other symptoms. The causes of postpartum depression are not clearly understood but have been attributed to various risk factors which include the steep drop in hormones that women experience after giving birth, changes in sleep pattern (Posmontier et al. “Sleep Quality in Women With and Without Postpartum Depression.” Journal of Obstetric Gynecologic & Neonatal Nursing, 2008; 37 (6): 722 abstract) and also changes in blood sugar (Katy Backes Kozhimannil et al. Association between diabetes and perinatal depression among low-income mothers. JAMA, Vol. 301, No. 8, February 25, 2009).
The Importance of Choosing the Right Medication to Treat Postpartum Depression in Nursing Mothers
Postpartum depression is a serious condition which affects both a mother and her infant and as such needs to be addressed. Postpartum depression can be treated by pharmacologic therapy by the use of antidepressants. Antidepressants consumed by the mother are generally available in the mother’s breast milk. Physicians use a risk and benefit analysis to determine the feasibility of the treatment of postpartum depression in nursing mothers.
Factors Influencing Antidepressant Medication Choice in Lactating Mothers
The extent of the postpartum depression is taken into account: whether severe, moderate or mild. This determines the treatment strategy or the need for medication. The mother’s well being is also taken into account as this has a direct impact on her care of her infant. The medication choice also depends on the specific antidepressant and its availability in breast milk. Antidepressants and antidepressant metabolites like all other xenobiotics are available at varied concentrations in the mother’s breast milk. Physicians are left to base their medication choice on the results of a handful of case studies that have monitored medication levels in breast milk.
Steps to Minimize Antidepressants Exposure to Nursing Infants
There are however some additional steps nursing mothers can take to minimize antidepressant medication exposure to their infant.
- Avoid breastfeeding when medications are at a peak in the mother’s system
- Pump and store breast milk before taking antidepressant medication
- Insist on medications that have low milk transfer rates
Besides updating study methodology, researchers are also working on making medications that are safe for infant exposure, especially in the case of infants exposed to antidepressant tainted breast milk over a long period of time.
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