I run this post of Dr. Hale's ..a repeat...
>Date: Tue, 24 Oct 1995 11:52:44 -0500
>From: "Dr. Tom Hale" <[log in to unmask]>
>Subject: Re: Antidepressants, Prozac
>
> 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
>
Kathleen B. Bruce, BSN, IBCLC, LLLeader, co-owner Lactnet, LLLOL, Corgi-L
LACTNET WWW site: http://www.mcs.com/~auerbach/lactation.html
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