The problem with fluoxetine is that it has a long half life and it has an
active metabolite which also has an active metabolite. If the mother is
taking this during pregnancy, then the baby will be loaded up with
fluoxetine and even small amounts received in the breastmilk might make him
toxic. If the mother must take fluoxetine during the pregnancy (the only one
approved for use during pregnancy), she should switch to sertraline or
paroxetine when the baby is born, or possibly go off fluoxetine 4 to 8 weeks
before the baby is born, if she needs absolutely needs, fluoxetine rather
than something else.
Hale lists references why sertraline and paroxetine would be safe for the
nursing mother and baby. Show those to the doctor. Also show the doctor
references for the risks of *not* breastfeeding. The argument always is we
are concerned what small amounts of the drug will do to the baby's
developing brain. This is a legitimate concern, but there is no evidence
that it does anything at all. On the other hand we do have evidence that the
drug which is commonly called infant formula does affect the baby's
developing brain. Weigh risks and benefits!!! Just a few references on the
negative effects of formula on the baby's developing brain. (sorry Kathleen
for the long post).
Jack Newman, MD, FRCPC
Andraca I, Uauy R. Breastfeeding for optimal mental development. Simopoulos
AP, Dutra de Oliveira JE, Desai ID (eds): Behavioral and Metabolic Aspects
of Breastfeeding. World Rev Nutr Diet. Basel, Karger, 1995;78:1-27 (review)
Gordon N. Nutrition and cognitive function. Brain and Development
1997;19:165-70 (Review)
Morrow-Tlucak M, Haude RH, Ernhart CB. Breastfeeding and cognitive
development in the first 2 years of life. Soc Sci Med 1988;26:635-9
Taylor B, Wadsworth J. Breastfeeding and child development at five years.
Dev Med Child Neurol 1984;26:73-80
Lucas A, Morley R, Cole TJ, Lister G, Leeson-Payne C. Breastmilk and
subsequent intelligence quotient in children born preterm. Lancet
1992;339:261-4
Nettleton JA. Are n-3 fatty acids essential nutrients for fetal and infant
development. J Am Diet Assoc 1993;93:58-64
Rogan WJ, Gladen BC. Breastfeeding and cognitive development. Early Hum Dev
1993;31:181-93
Silver LB, Levinson RB, Laskin CR, Pilot LJ. Learning disabilities as a
probable consequence of using chloride-deficient infant formula. J Pediatr
1989;115:97-9
Willoughby A, Moss HA, Hubbard VS, Bercu BB, Graubard BI, Vietze PM, et al.
Developmental outcome in children exposed to chloride deficient formula.
Pediatrics 1987;79:851-7
Wing CS. Defective infant formulas and expressive language problems: a case
study. Language, Speech and Hearing Services in Schools 1990;21:22-7
Crawford MA. The role of essential fatty acids in neural development:
implications for perinatal nutrition. Am J Clin Nutr 1993;57(suppl):703S-10S
Temboury MC, Otero A, Polanco I, Arribas E. Influence of breastfeeding on
the infant's intellectual development. J Pediatric Gastroenterol Nutr
1994;18:32-36
Pollock JI. Longterm associations with infant feeding in a clinically
advantaged population of babies. Dev Med Child Neur 1994;36:429-40
Makrides M, Neumann MA, Byard RW, Simmer K, Gibson RA. Fatty acid
composition of brain, retina and erythrocytes in breast and formula fed
infants. Am J Clin Nutr 1994;60:189-94
Anderson GJ, Connor WE, Corliss JD. Docosohexaenoic acid is the preferred
dietary n-3 fatty acid for the development of the brain and retina. Pediatr
Res 1990;27:87-97
Neuringer M, Connor WE, Lin DS, Barstad L, Luck S. Biochemical and
functional effects of prenatal and postnatal fatty acid deficiency on retina
and brain in rhesus monkeys. Proc Natl Acad Sc USA 1986;83:4021-5
Florey C Du V, Leech AM, Blackhall A. Infant feeding and mental and motor
development at 18 months of age in first born singletons. Int J Epidem
1995;24 (Suppl 1):S21-6
Wang YS, Wu SY. The effect of exclusive breastfeeding on development and
incidence of infection in infants. JHL 1996;12:27-30
Greene LC, Lucas A, Livingstone BE, Harland PSEG, Baker BA. Relationship
between early diet and subsequent cognitive performance during adolescence.
Biochem Soc Trans 1995;23:376S
Riva E, Agostoni C, Biasucci G, Trojan S, Luotti D, Fiori L, et al. Early
breastfeeding is linked to higher intelligence quotient scores in dietary
treated phenylketonuric children. Acta Pædiatr 1996;85:56-8
Niemelä A, Järvenpää A-L. Is breastfeeding beneficial and maternal smoking
harmful to the cognitive development of children? Acta Pædiatr
1996;85:1202-6
Rodgers B. Feeding in infancy and later ability and attainment: a
longitudinal study. Devel Med Child Neurol 1978;20:421-6
Horwood LJ, Fergusson DM. Breastfeeding and later cognitive and academic
outcomes. Pediatrics 1998;101:p. e9
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