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>RE:  You suggest that mothers can continue to breastfeed while on
antidepressants. I have found that there is mixed opinion on this topic.  I
would welcome>some discussion on what antidepressants are appropriate and
which are not as well as why.
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>Denise:

My apologies for taking so long in responding - I noticed no one else
commented on this topic either.  I wanted to gather some information.  I
would like to preface comments about medication and breastfeeding by saying
this is the domain of physicians and pharmacists, but I think it is
important for LC's to be able to direct mothers to resources where current
accurate information is available.  Also as we are all well aware most drugs
pass into breastmilk, almost all medications appear in small amounts and
very few are actually contraindicated for breastfeeding women. There are
several factors that either encourage or discourage the passage of a drug
into the milk but an important piece of information for us to be aware of is
the half life of the drug in both the adult and the infant.

Some of the references I have dug up go from old to new , and may be of
interest include:  Chasnoff, I. (1988) Drugs, alcohol, pregnancy and
Parenting (Ed.)Discusses tricyclic antidepressants such as amytryptilline,
desipramine as being secreted in small amounts in breastmilk.  However, no
side effects on the neurotransmitter system of the neonate has been found so
far. He states Lithium is contraindicated because it affects amine
metabolism and the infant experiences cyanosis, poor muscle tone and ECG
changes.

Tom Hale in Medications and Mothers' Milk (1994) says desipramine has not
been found in infants blood and no untoward effects have been reported the
adult half life is 12 - 24 hours.  He says the American Academy of pediatris
has lited it as compatible with breastfeeding. However long-term effects are
unknown. He also has concerns about Lithium.

Ito, Blajcheman, et al (1993). Prospective follow-up of adverse reactions in
breast-fed infants exposed to maternal mediaction. American Journal of
Obstetrics and Gynecology. Vol 168 # 5 p. 1393 - 9.  Characterized the
short-term effects of maternal medication on breastfeeding infants.

They looked at quite large numbers of women and concluded that the short
term effects if any of most maternal medications on Breastfeeding infants
are milk and pose little risk to the infants.  They looked at a # of
categories of drugs one of which was sedatives, antidepressants or
antiepileptics.  They established a MotherRisk Program to collect data on
large numbers of women because of labelling a drug dangerous based on single
case reports.

The committee on drugs. The transfer of drugs and other chemicals into human
milk. Pediatrics Vol 93, no. 1, Jan 1994 from the American Academy of
Pediatrics made four recommendations when prescribing to a lactating women,
1. Is the drug therapy really necessary? Consultation between the
pediatrician and the mother's physician can be most useful.
2. Use the safest drug for example acetaminophen rather than aspirin for
analgesia.
3. If there is a possibility that a drug may present a risk to the infant,
consideration should be given to measurement of blood concentrations in the
nursing infant.
4. Drug exposure to the nursing infant may be minimized by having the mother
take the medication just after she has breast-fed the infant and/or just
before the infant is due to have a lengthy sleep period.

I would add something else taking into consideration the woman as an
individual, for example what is the worst scenario if I tell this women she
cannot breastfeed while taking this drug.

In Ottawa a few years ago we had a major tragedy, a mother of two children
who had previously required Lithium was told she could not breastfeed while
taking this drug.  She was determined to normalize her situation with her
second child and breastfeed.She went off the Lithium and when the second
infant was ten months old, her husband left for a business trip she killed
both children and herself.

I know what you are thinking why wasn't she being monitored, why didn't her
husband recognize problems etc. The fact is it happened and while these are
isolated cases could it have been prevented with very careful monitoring and
allowing her to stay on the Lithium.

I thought I had read somewhere that Lithium was being taken off the
restricted list for this very reason, but I could not find the reference, it
may have been in a previous publication by the American Academy of
Pediatricians or it may have been in the Canadian Pediatric Society's
guidelines.

Presently the AAP has listed Lithium as contraindicated and lists
antianxiety and antidepressants as drugs whose effect on nursing infants is
unknown but may be of concern.

I would welcome further discussion on this topic.

Susan Moxley IBCLC
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