Medications Used to Treat Postpartum Depression
A General Review of Effects of Antidepressants on Lactating Women
Aug 15, 2009
Studies done to determine the effect that antidepressants have on nursing infants have been insufficient. Most of the studies use the precept of the availability of the medication in the mother’s breast milk as the measure of infant exposure, while some studies use unrealistically small sample sizes.
Medications Used to Treat Postpartum Depression in Lactating Mothers
Most pharmacological interventions to postpartum depression are directed at combating the changes in the brain function that causes depression; namely the neurotransmitters serotonin and norepinephrine. Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed since they are considered lower risk in cases of an overdose. These drugs include Celexa, Prozac, Luvox, Paxil and Zoloft. Physicians base their choice on several factors which include the mother’s history and the severity of the condition, (Altshuler L, Burt VK. “The Use of Psychotropic Medications During Breast-Feeding.” The American Journal of Psychiatry 2001; 158:1001-9 Article).
What Happens to Antidepressants in a Nursing Mother’s Body
Antidepressants are commonly prescribed as pills and ingested orally. The medications are absorbed by the body rapidly, taking on average 2 to 4 hours to reach peak levels in the nursing mother’s body. The medications are lipophilic tending to accumulate in fat tissues and are found at high concentrations in the brain (target organ) and also in cardiac tissue. Since the medications are found in the blood serum, they are also available in the breast milk. The medications are eventually cleared from the blood by the liver where they are metabolized.
Possible Side Effects of Medications on Nursing Infants
An infant's immature liver may not have the same clearing ability as the maternal elimination system. This could lead to increasing medication levels in the nursing infant. One study found Prozac in breastfed infant’s plasma. The infants showed obvious drug exposure effects that included irritability, upset stomach and interrupted sleep (Gjerdingen D. "The Effectiveness of Various Postpartum Depression Treatments and the Impact of Antidepressant Drugs on Nursing Infants." The Journal of the American Board of Family Practice. 2003:16:372-82 Article). Infants should be carefully monitored and evaluated for changes in behavior which results from exposure to maternal medication. More adverse reactions include respiration depression, agitation, irritability and extreme changes in bowel and bladder function.
To ensure infant safety from antidepressant exposure from maternal breast milk, medication levels in infants should be tested regularly. Mothers should check for behavior changes in their nursing infants. The research community should design better studies that delve into long term effects of antidepressant exposure. Most studies only report acute adverse effects.
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