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.
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St.Peter Hospital Family Practice Residency
Olympia, WA