I am a nursing student from the University of North Dakota.  Over the past
year, our childbearing and child health classes have stressed the
importance of breastfeeding.  I know that postpartum depression
unfortunately occurs in some mothers, so I was curious about the effects
of antidepressants on the breastfeeding infants.

I discovered at the beginning of my research that more testing needs to be
performed before a definite "yes" or "no" to breastfeeding while on
antidepressants is stated.  The American Academy of Pediatrics Committee
on Drugs, as quoted by Fotini Hatzopoulos and Lisa Albrecht (1996), has
reclassified antidepressants as "drugs whose effect on nursing infants is
unknown but may be of concern" (p. 139).  Hatzopoulos and Albrecht go on
to say that because there is no absolute contraindication to breastfeeding
during antidepressant use, recommendations should be made on case-by-case
basis limited to healthy term infants (p. 141).

James B. Longhurst, M.D., and Erica Weiss, M.D. (1998) seem to agree,
stating "...given the enormous benefits associated with breastfeeding, the
significant risks posed by untreated maternal depression, the mounting
evidence that SSRI's are not found in significant quantities in infant
plasma, and early data suggesting they do not produce measurable changes
in infant serotonin transport, we feel that all women suffering from
significant postpartum depressionshould be offered appropriate
antidepressant treatment unless there is a clear contraindication in an
indiviual case" (p. 1643).

In a study performed by Yoshida, Smith, Craggs, and Kumar (1998), 12
mothers who breastfed their infants were prescribed haloperidol,
chlorpromazine, or trifluoperazine.  Three of these mothers were
simultaneously taking haloperidol and chlorpromazine, and their infants
had substantial falls in the Bayley Scale Scores by 12-18 months.  The
nine infants whose mothers were prescribed individual drugs demonstrated
no developmental delays (pp. 88-89).  Yoshida et al (1998) state that
breastfeeding mothers, such as those in the co-medicated subgroup, and
those prescribed individual drugs at the upper end of the recommended dose
range, not breatfeed (p. 91).

From the research I have done, I believe it is better to choose
a compatible drug to preserve a breastfeeding relationship than to not
treat maternal depression at all.  Any comments on what you have seen in
practice?

Anna Meidinger, SN, UND

Hatzopoulos, F.K., and Albrecht, L.M. (1996).  Antidepressant use during
        breastfeeding.  Journal of Human Lactation, 12 (2), 139-141.

Longhurst, J.G., and Weiss, E. (1998).  Use of psychotropic medications
        during lactation.  American Journal of Psychiatry, 155(11), 1643).

Yoshida, K., Smith, B., Craggs, M., and Kumar, R. (1998).  Neuroleptic
        drugs in breast-milk:  A study of pharmacokinetics and of possible
        adverse effects in breast-fed infants.  Psychological Medicine,
        28, 81-91.