From Medscape
SSRIs Relatively Safe While Nursing

Roberta Friedman, PhD

May 20, 2003 (San Francisco) - Tests of five different selective serotonin
reuptake inhibitors (SSRIs) show they do not enter a mother's milk in
significant amounts, so nursing women can safely take these medications to
treat postpartum depression. Findings on 23 nursing women and their babies
were reported here at the 156th annual meeting of the American Psychiatric
Association.

Norwegian scientists presented a study in which they collected samples of
milk from 23 women nursing their babies. The mothers were taking one of five
commonly used SSRIs. One woman had twins, so blood from 24 babies in all
were sampled, along with serum from their mothers.

"I think it's pretty safe" for mothers to take these drugs and nurse, said
lead investigator Jan Oystein Berle, MD, in an interview with Medscape.

Nine mothers were taking citalopram, and five each were taking sertraline or
paroxetine. Three were taking venlafaxine, and one was taking fluoxetine.

Milk drug levels were the mean of eight samples, which mothers provided both
from the initial milk on nursing, and from residual milk after nursing.
Blood was sampled from the babies by heel stick and other methods, said Dr.
Berle, a research fellow in the Center for Child and Adolescent Psychiatry
at the University of Bergen in Norway.

For sertraline and paroxetine, blood drug levels in babies were below the
limit of detection. For citalopram, the babies on average showed 1.9 nmol/L.
Fluoxetine and venlafaxine analysis yielded levels in babies of 47 and 91
nmol/L, respectively, but these levels included the active metabolites of
these drugs.

Drug levels in babies ranged from zero to 10% of that in the mothers' blood.
The women took doses of 20 to 130 mg per day. Their serum drug levels fell
within the therapeutic range, the researchers write in the poster.

Not only do these data support safe nursing, Dr. Berle said, but several
studies also show that women who take these drugs while pregnant do not risk
birth defects for their children.

Notably, one mother and her baby both turned out to be slow metabolizers,
with the enzyme variant CYP2D6, the major enzyme involved in processing
paroxetine. "This is what you would call the worst-case scenario," Dr. Berle
said, yet no trace of drug appeared in the child's bloodstream.

The investigators could not find any specific behavioral or physical changes
in the infants of mothers taking the antidepressants. For comparison, 68
nursed babies whose mothers did not take medications were measured and
screened. They were of similar age, weight, length, sex ratio, and showed
similar symptom scores.

The findings are good news for mothers who might be concerned about treating
their depression during the early days of their babies' lives. "Most of them
want to" suckle their infants, said Roger Samuel, MD, who is in private
practice in Boca Raton, Florida, and also carries out research.

"One way to get a depressed woman to connect with her child is to [have her]
breast-feed." And based on the study, Dr. Samuel told Medscape, "you can
reasonably assure them it's a good option."

H. Lundbeck A/S, marketer of citalopram, supported the study.

APA 156th Annual Meeting: Abstract NR199. Presented May 19, 2003.

Reviewed by Gary D. Vogin, MD


cheers
Karen clements IBCLC
Melb Aust
(whoose spellcheck is still correcting google to goggle LOL)

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