Hi, my name is Roxanne Tohm and I am a junior nursing student at the
University of North Dakota. I am participating in a childbearing class and
clinicals right now. I’m very interested in working in this area, so I
joined this listserv to learn more.
Recently, I had visited with a lady who was diagnosed with postpartum
depression, but still decided to breastfeed. I had some questions on how the
medication would affect breastfeeding, so I did some research. I found that
selective serotonin reuptake inhibitors (SSRI’s) are the medication most
often being prescribed due to the fact that they have the least amount of
side effects. Gjerdingen (2003) found paroxetine (SSRI), sertraline (SSRI),
and nortriptyline (TCA) to be the most widely studied antidepressants with
no adverse effects on breastfeeding infants. Hendrick (2003) stated new
mothers do not need to discontinue breastfeeding if they are taking certain
antidepressants. Epperson, Jatlow, Czarkowski, and Anderson (2003) studied
infants whose mothers were taking SSRI’s and breastfeeding, and the results
showed that the plasma drug levels of infants who are exposed to SSRI’s
through breast milk have been low. However, the concern with this medication
was that the levels of platelet 5-HT concentrations were shown to be
slightly lowered, and the impact of this on brain development was unknown.
But, the end conclusion was that most infants may continue to breastfeed
without experiencing meaningful changes in platelet 5-HT transport while
their mothers were taking 20-40mg of fluoxetine, and no other side effects
were mentioned.
Even though findings of antidepressant drugs while breastfeeding have been
shown to have no adverse effects, some mothers might not want to take them.
I was wondering if anyone has taken care of a patient who has had trouble
with these, and if so, what was it. I was also curious about any
nonpharmocological therapies that people have tried and if they worked.
Thank you,
Roxanne Tohm, SN
Epperson, Neil C., Jatlow, Peter I., Czarkowski, Kathryn, Anderson, George
M. (2003).
Maternal Fluoxetine Treatment in the Postpartum Period: Effects on Platelet
Serotonin and Plama Drug Levels in Breastfeeding Mother-Infant Pairs.
Pediatrics, 112 (5), 425-429.
Gjerdingen, Dwenda. (2003, September-October). The Effectiveness of Various
Postpartum
Depression Treatments and the Impact of Antidepressant Drugs on Nursing
Infants. The
Journal of the American Board of Family Practice, 16 (5), 372-380.
Hendrick, Victoria. (2003, November). Treatment of postnatal depression.
BMJ, 327,
1003-1004.
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