Linda Rosetti :

        In reference to your question on Prozac.   I know there is a great
urgency to use the antidepressants in lactating women,  and I also know that
they have been used by a large number of women.   But to be real honest
about this subject,  I'm very nervous about this process,  particularly
because there is an absolute vacuum of information on the long-term
psychologic development in children exposed to these compounds.

        Two good papers have been published on Prozac in lactating women.
Both papers showed significant transfer of Prozac via breastmilk.  To me,
the most damning paper was published in 1993(J.Am.Acad. Adolesc. Psy.
32:1253, 1993) in which a mom taking 20 mg Fluoxetine daily produced plasma
levels in her infant equal to or higher than her own plasma level.   In
essence,  the infant's plasma levels were in the  high therapeutic range.
This infant was irritable and colicy,  and returned to normal when the mom
discontinued Prozac.

        A recent paper on Sertraline(Zoloft)  showed low breastmilk levels,
but there was none detected in the Plasma compartment of the infant.  This
is probably due to the fact that it has a much shorter half-life than
Prozac,  and may not build up with time in the infant.  However,  just
because you have minimum plasma levels,  does not necessarily indicate  drug
levels in the CNS compartment,  and we should be hesitant to jump into using
this family of drugs based on this one study.

        At this time there is a body of evidence indicating that the
Tricyclic Antidepressants(Elavil, desipramine, etc) only produce modest to
low breastmilk levels and presumably low plasma levels in the infant.  Again
we have no long-term data suggesting these children are psychologically
normal,  although we presume they are.

        Using antidepressants in the first year of an infants life  MAY be
very risky.  During the first year of life,  the brain will double in size,
and makes millions of new inter-neuronal connections that make us who we
are.   Making these connections under the influence of drugs that alter
synaptic neurotransmitter levels  is incredibly  risky.    This is one
situation,  where a terribly strong justification is required prior to
medicating mom with these powerful neuroleptic drugs.

          I'm just old enough to remember diethylstilbesterol and cervical
cancer in female offspring,  the thalidomide birth defects,  and the IQ
deficit produced by prolonged pediatric exposure to phenobarbital and
dilantin.   Lets just say I've been burned before by "SAFE" drugs.

Tom Hale