> > >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. > >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 [log in to unmask] >