by Carolyn Joslin

Created on: June 15, 2009

New moms, even those who already have kids, face a lot of challenging decisions in the first few weeks of their baby's life. One of these can be trying to weigh the risks and benefits of breastfeeding and antidepressants. There are actually a couple of things to consider with this decision. First off, can you, as mom and a caregiver for this child (and maybe more) regulate your emotions, words, and actions without medication? Can you be an effective parent without medication? Second, what medications are safe for you to take while nursing? The answer to the first question is subjective. No one but you can tell you whether or not to start or continue taking antidepressants while nursing. The answer to the second question is much more concrete. Here are some of the most common antidepressants, their classification by the FDA, and what this means to you and your baby.

Fluvoxamine (Luvox), paroxetine (Paxil) and sertraline (Zoloft) all present in the baby's blood but at much lower rates than in the mother. These antidepressants tend to pass through baby's system fairly quickly and without many side-effects. Concerns that have been noted are: increased crying, sleep disturbance, and softer / looser stools. Br J Clin Pharmacol1997 Sep;44(3):295-8

Zoloft (sertraline) is by far the most commonly-prescribed antidepressant for nursing moms as it has been shown that on average 0.3% of mom's dose is actually transferred to baby, making it the safest medication to use.

Wellbutrin (bupropion) has been clinically shown to appear in breast milk at twice the rate that it appears in a woman's blood. HOWEVER, when breastfed infants of these women are tested, the medication does not appear in their blood in any significant amounts. The working hypothesis for this is that the medication ingested in the breast milk is not absorbed into the infant's body but rather passes through it. Ann Pharmacother 1993 Apr;27(4):431-3; J Clin Psychiatry 2002 Oct;63(10):910-1

Tri-cyclic antidepressants (Pamelor, Elavil, Doxepin, etc) tend to all be classified together for two reasons: not much research has been done on them in regard to transmission through breast milk, and not many people still take them. These medication tend to have higher frequencies of (and more severe) side effects and have largely been replaced by SSRI and SNRI classifications of antidepressants. The most common side effects reported in infants in studies of tri-cyclics were apnea (brief periods of breath-holding or not breathing) and lethargy. J Psychopharmacol 1999;13(1):64-80

Medications with higher reported incidence of side-effects for baby include Prozac and Doxepin as Prozac has been known to cause quick and significant changes in baby's stool, sleep patterns, and irritability and Doxepin has been shown to cause apnea (a cessation in breathing for seconds up to a minute).

Obviously any medication you, as mom, take will be transferred to your infant in some amount. The most important questions to consider are: how much will transfer, what will it do to baby, and is the transfer necessary or can mom either avoid use of antidepressants or switch to formula instead? While the questions and decisions can be confusing and intimidating, most primary care doctors and OB/GYN doctors have a significant amount of information about antidepressants and can help you make an informed and health decision.

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