To      Amy Shelton
Re      Antidepressants

The antidepressant issue in breastfeeding mothers is an issue that has no good
answer.  It is complicated by the fact that in some of these women,
medications are cricially needed.  The complication is  what the medication
will do to the developing brain of an infant.  So basically it calls for a
needs assessment.  Having reviewed all the literature in this field with
relation to the medications used,  it is my opinion that Prozac should not be
used in breastfeeding mothers.  Rather,  Zoloft is preferred due to its shorter
half-life and higher protein binding.  But it does penetrate milk to a
significant degree, but neonatal plasma levels appear very low.

But support for Zoloft is only a preliminary conclusion, as only one paper
exists on Zoloft use in Bfing moms and it is weak due to the limited sample
size (one).  So I still think you should use caution and observe the infant
very closely for side effects,  and use the smallest dose possible.

-------------------------------------

To      Karen Evon
Re      Xanax  (One dose)

As for pumping and dumping following a single dose of Xanax,  I tend to believe
this may have been unnecessary.  Although Xanax is a benzodiazepine,  it has a
large volume of distribution and it would have rapidly distributed to other
tissues and the plasma levels would have been quite small,  hence, exposure of
the infant would have been minimal.  With therapy over several days,  however,
it could have caused significant sedation in the infant.  In a premie with
apnea or weakness, however, I would have pumped and dumped.


Regards

Tom Hale