I run this post of Dr. Hale's ..a repeat...

>Date:    Tue, 24 Oct 1995 11:52:44 -0500
>From:    "Dr. Tom Hale" <[log in to unmask]>
>Subject: Re: Antidepressants,  Prozac
>
>  Linda Rosetti :
>
>        In reference to your question on Prozac.   I know there is a great
>urgency to use the antidepressants in lactating women,  and I also know that
>they have been used by a large number of women.   But to be real honest
>about this subject,  I'm very nervous about this process,  particularly
>because there is an absolute vacuum of information on the long-term
>psychologic development in children exposed to these compounds.
>
>        Two good papers have been published on Prozac in lactating women.
>Both papers showed significant transfer of Prozac via breastmilk.  To me,
>the most damning paper was published in 1993(J.Am.Acad. Adolesc. Psy.
>32:1253, 1993) in which a mom taking 20 mg Fluoxetine daily produced plasma
>levels in her infant equal to or higher than her own plasma level.   In
>essence,  the infant's plasma levels were in the  high therapeutic range.
>This infant was irritable and colicy,  and returned to normal when the mom
>discontinued Prozac.
>
>        A recent paper on Sertraline(Zoloft)  showed low breastmilk levels,
>but there was none detected in the Plasma compartment of the infant.  This
>is probably due to the fact that it has a much shorter half-life than
>Prozac,  and may not build up with time in the infant.  However,  just
>because you have minimum plasma levels,  does not necessarily indicate  drug
>levels in the CNS compartment,  and we should be hesitant to jump into using
>this family of drugs based on this one study.
>
>        At this time there is a body of evidence indicating that the
>Tricyclic Antidepressants(Elavil, desipramine, etc) only produce modest to
>low breastmilk levels and presumably low plasma levels in the infant.  Again
>we have no long-term data suggesting these children are psychologically
>normal,  although we presume they are.
>
>        Using antidepressants in the first year of an infants life  MAY be
>very risky.  During the first year of life,  the brain will double in size,
>and makes millions of new inter-neuronal connections that make us who we
>are.   Making these connections under the influence of drugs that alter
>synaptic neurotransmitter levels  is incredibly  risky.    This is one
>situation,  where a terribly strong justification is required prior to
>medicating mom with these powerful neuroleptic drugs.
>
>          I'm just old enough to remember diethylstilbesterol and cervical
>cancer in female offspring,  the thalidomide birth defects,  and the IQ
>deficit produced by prolonged pediatric exposure to phenobarbital and
>dilantin.   Lets just say I've been burned before by "SAFE" drugs.
>
>Tom Hale
>

Kathleen B. Bruce, BSN, IBCLC, LLLeader, co-owner Lactnet, LLLOL, Corgi-L
LACTNET WWW site: http://www.mcs.com/~auerbach/lactation.html