Antidepressants and Breastfeeding - Safest?

[Blitz2006]

Any thoughts on which antidepressant safest for patients who are breastfeeding?

My literature search suggests:

Antidepressant Medication Use during Breastfeeding - PMC

We performed an electronic search by using MEDLINE, PreMEDLINE, Current Contents, Biological Abstracts, and PsycINFO from June 2002 through December 2008 using the following terms: “antidepressant drugs”, “antidepressive agents”, “human milk”, ...

www.ncbi.nlm.nih.gov

"Sertraline, paroxetine, nortriptyline and imipramine are the most evidence-based medications for use during breastfeeding."

Antidepressant Use During Breastfeeding - PMC

The treatment of breastfeeding mothers with depression raises several dilemmas, including the possible risk of drug exposure through breast milk for the infant. This article provides background information and presents practical advice and ...

www.ncbi.nlm.nih.gov

"Paroxetine and sertraline are most likely suitable first-line agents. Although some concern has been expressed for fluoxetine, citalopram and venlafaxine, we nevertheless consider that if the 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."

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[splik]

If you are starting an antidepressant de novo in a pt who is breastfeeding then setraline is the preferred one. However, if the pt is already on a med, you wouldnt normally change it. Also if they have responded favorably to an antidepressant in the past, you would probably just use whatever that one was. Can use Lactmed to get more info on specific drugs.

You can always contact the PSI perintal psych line for a consult if you have any questions about perinatal patients Perinatal Psychiatric Consult Line | Postpartum Support International (PSI)

 

[calvnandhobbs68]

Yeah agree with splik what I've always heard from repro psych is that there's most evidence for safety for Zoloft so if you're starting something new, start there. But general principles are try to keep people on whatever has kept them stable prior to pregnancy as the risk to baby from an uncontrolled psychiatric condition is much higher than theoretical risk from many medications.