Andrea, I'll send you what Hale says. Also here is how to order your Hale book, Medications and Mother's Milk 1997. Call: 800-378-1317 Single copies 19.95 Shipping 3.00 Total 22.95 Wellbutrin (Buprpoion) Antidepressant with a structure unrelated to tricyclics. May be teratogenic in pregnant women. One report in the literature indicates that bupropion probably accumulates in human milk. Following one 100 mg dose in a mother the milk:plasma ratio ranged from 2.52 to 8.58, clearly suggesting a concentrating mechanism for this drug in human milk. However, plasma levels of bupropion in the infant were undetectable (however this infant was only breastfed twice daily.). The peak milk bupropion level (0.189 mg/L) occruued two hours after a 100 mg dose. This milk level would be 0.-19% of the maternal dose. HALE ___________________________________________ There are many other antidepressants that have been shown to be safe. I suggest that you tell the mother that and that she tell her HCP strongly that she does want to continue feeding her baby and ask him if there is another antidepressant that he could recommend. In Hale's book he tells which ones are the tricyclics, which seem to be the safer ones for the breastfeeding mother. Pat Gima Here are a couple of posts on this topic: From: Julie Cold Kissack <[log in to unmask]> Subject: Paxil and Prozac Comments: cc: [log in to unmask] To: [log in to unmask] X-UIDL: 869682179.021 Both Paxil (paroxetine) and Prozac (fluoxetine) are relatively 'new antidepressants'. There are selective serotonin reuptake inhibitors and are considered first line treatments for depression by many clinicians. Therefore, I suspect you will continue to see moms who are treated with these meds. The side effects from these meds are GENERALLY less bothersome than with the older antidepressants. From the limited data available about the use of these drugs in breastfeeding moms it appears that the child is exposed to the drug but at a much reduced quantity. I doubt that you will find any reference that says unequivocally that it is OK to use these drugs in the bf moms since we don't know what the long term effects of the small or minimal exposure might be to the child. I believe you need to weigh the risks and the benefits of drug treatment and if use of the medication means that the mom's depression is resolved and she is better able to parent then the benefit outweighs the risk (IMO). Good luck with your clients, Julie Cold Kissack *************************************************************************** Julie Cold, Pharm.D., BCPP office # 770 986-3208 Assistant Professor of Pharmacy Practice fax # 770 986-3384 Mercer University Southern School of Pharmacy digital beeper 404 225-2404 Atlanta, GA. 30341 *************************************************************************** From: "A. Montgomery" <[log in to unmask]> Subject: Paxil To: Multiple recipients of list LACTNET <[log in to unmask]> X-UIDL: 845946897.006 Paxil is one of the SSRI drugs that are not really contraindicated in breastfeeding but about which the AAP recommends caution. The long-term effect of these drugs on the developing infant's brain are not known. However, we *do* know that maternal depression has a significant negative effect on infant emotional development. I used informed consent with these drugs, and feel it is important to treat maternal depression including the use of medications if indicated. I believe Paxil may be the best choice of the SSRI's for breastfeeding mothers, as less of it gets in the milk. In general, I think the advantages of breastmilk plus a happy mother probably outweigh the potential disadvantages of using antidepressant meds, but a cautious approach (lowest possible dose, etc.) is warranted. -- Anne Montgomery, M.D. [log in to unmask] St.Peter Hospital Family Practice Residency From: Jack Newman <[log in to unmask]> Subject: Antidepressants Comments: cc: "Ray L. Henninger & Ann Trebon" <[log in to unmask]> MIME-Version: 1.0 Content-Type: text/plain; charset=us-ascii Content-Transfer-Encoding: 7bit Paxil is one antidepressant which is probably one of the safest for breastfeeding mothers. Very little gets into the milk. Zoloft is another which is very safe, showing no effect on the baby (New England Journal of Medicine, April 17, 1997). Jack Newman, MD, FRCPC From: Alicia Dermer <[log in to unmask]> Subject: tricyclic antidepressants and breastfeeding Comments: To: Kelly Jean Stauss <[log in to unmask]> To: [log in to unmask] X-UIDL: 877044614.000 Kelly: There was an excellent review article by Wisner, et al, in the Aug 1996 American Journal of Psychiatry. Sorry, I don't have the full reference with me (I can get it for you if you can't find it in the archives). I just found two even more recent references: Wisner KL, Perel JM, Findling RL, Hinnes RL. Nortriptyline and its hydroxymetabolites in breastfeeding mothers and newborns. Psychopharmacology Bulletin. 33(2):249-51, 1997. The authors, who previously had not detected nortriptyline in breastfed babies, report on two infants aged 10 weeks or less who were found to have low concentrations of the metabolite, and 6 more dyads with babies 4 weeks of age, and one premature baby. One infant had quantifiable nortriptyline levels, and another had metabolites, but still the levels were very low and no adverse clinical effects were noted. Yoshida K, Smith B, Craggs M, Kumar RC. Investigation of pharmacokinetics and of possible adverse effects in infants exposed to tricyclic antidepressants in breast-milk. Journal of Affective Disorders. 43(3):225-37, 1997 May. Ten dyads were compared with a bottle-feeding group (presumably with mothers on tricyclics), and monitored for health and development for 30 months. The breastfed infants got a daily dose of about 1% of the maternal dose, very small amounts of the meds were detected in the babies. No adverse effects nor developmental delays were noted. There is now a good body of evidence that tricyclic antidepressants pose little, if any, risk to breastfed babies. We always need to remember all the known risks of artificial feeding and balance them against the small risk of the medication. Hope this helps. Alicia Dermer, MD, IBCLC. mailto:[log in to unmask]