TO save Tom the trouble of mentioning this again (WISH WE HAD ARCHIVES BY
TOPIC!!), here is the info.

For all of you who rely on Tom Hale's Drug information, please be aware that
he has a book on this subject. It might behoove all of us to purchase a copy
for our own use, ..I thank everyone who takes the time to share info on
Lactnet, even when repetitive...I guess we help mothers one by
one...beginning here ...with each of us.


Tom, please give the title, publisher, and particulars of the book that you
have written.  People may email you privately for price, etc.  I know many
will want to get a copy. We do not allow advertising, etc of books, etc or
conferences, etc..but I think that we have a special circumstance
here...where someone take as LOT of time to answer repetitive questions for
the benefit of bf mothers everywhere.

Thankfully to all, and especially to Tom Hale

Kathleen


>X-Attachments:
>
>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
>
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Kathleen B. Bruce, BSN, IBCLC, LLL Leader
Co-Owner Lactnet, LLLOL, Corgi-L E-mail lists
LACTNET WWW site: http://www.mcs.com/~auerbach/lactation.html
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