What I would say to a mother -- and many moms keep up very well with
internet-available information on their disorders -- is just what you've
reviewed about extrapolation and correlation.  I hope it is in our scope of
practice to suggest that a second physician opinion may be necessary, if
there is a change in her prescription in response to recent studies which
have no clear bearing on her situation as a lactating human.  And I really
hope that physicians will be scientific rather than reactive, so that we
don't encounter such a situation.

Maternal depression is such a salient topic for us, since it can cripple or
distort the maternal behaviors that we count on breastfeeding to foster.
 Thanks for bringing up an article that highlights that there are many
investigations underway about methods and implications of the treatment of
maternal depression -- and that we may be asked to lend a mom some
perspective.

Ruth Piatak, BA, MS
La Leche League Leader
WIC Breastfeeding Peer Counselor
Tulsa, Oklahoma
214-886-1218 (cell)
918-585-9114 (home)
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Date:    Wed, 26 Oct 2011 16:54:38 -0500
From:    "Furr, Sara" <[log in to unmask]>
Subject: Antidepressants and brain development in offspring

I did not suggest that we extrapolate from the rat data.  Nor did I suggest
that we (IBCLCs) make any suggestions to mothers regarding whether they
should or should not be taking SSRIs.  I do understand the leap from rat
data to human data and I also understand the difference between correlation
and causation.

My concern is that this study could lead to a change in prescribing
behaviors (I can't prescribe) and that we may, perhaps, see more depressed
mothers.  Who knows what the effect will be?  Rats are used in research all
of the time and of course it is unethical to have randomized controlled
trials with human mothers so this is the only data we have.  I would never
tell a mother that a drug is 100% safe or that it is not.

I was hoping to have a conversation on what we might realistically say to a
mother who is concerned about using SSRIs during pregnancy or lactation.


Sara Dodder Furr, MA, LLLL, IBCLC
Quality Improvement Specialist
Office of Research, Policy & Quality Improvement
Health Licensure & Investigations Unit, DHHS Division of Public Health
P.O. Box 95206
Lincoln NE 68509-5026
Phone:  (402) 471-4973 FAX:  (402) 471-0383
[log in to unmask]
Website: http://www.dhhs.ne.gov/crl/crlindex.htm

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