To Leslie A-J:

        In reference to your question concerning Doxepin use in a mom with a
17 month old child.    Of the tricyclic antidepressants,  Doxepin is
probably the worst choice to use,  several reports suggest problems with
this compound in breastfed infants.   There are a whole host of better
choices,  imipramine, desipramine, sertraline, etc.

        The first question I have is how often the mom breastfeeds...if only
occassionally, once or twice daily,  I would doubt that the infant would
receive a significant dose of  any of these antidepressants with this
exposure.  She might choose to cut back to several breastfeeding sessions
daily,  hence reducing the infants exposure while still continuing to enjoy
breastfeeding.

        Of the SSRIs,   sertraline is probably preferred in a BFing mom.
Of the tricyclics,  imipramine and desipramine are probably preferred.

        Again however,  the long-term sequalae from exposure to these
compounds at this age is unknown in infants,  and I still would be very
cautious.



Tom Hale