Antidepressant drugs and breastfeeding: a review of the literature.
The use of antidepressants in breastfeeding mothers is controversial: Manufacters often routinely discourage breastfeeding for the nursing mother despite the well-known positive impact that breastfeeding carries on the health of the nursing infant and on his or her family and society. We conducted a systematic review of drugs commonly used in the treatment of postpartum depression. For every single drug two sets of data were provided: (1) selected pharmacokinetic characteristics such as half-life, milk-to-plasma ratio, protein binding, and oral bioavailability and (2) information about lactational risk, according to some authoritative sources of the literature: Drugs in Pregnancy and Lactation edited by Briggs et al. (Lippincott Williams, Philadelphia, 2008), Medications and Mothers' Milk by Hale (Hale Publishing, Amarillo, TX, 2010), and the LactMed database of TOXNET ( www.pubmed.gov ; accessed June 2010). Notwithstanding a certain variability of advice, we found that (1) knowledge of pharmacokinetic characteristics are scarcely useful to assess safety and (2) the majority of antidepressants are not usually contraindicated: (a) Selective serotinin reuptake inhibitors and nortryptiline have a better safety profile during lactation, (b) fluoxetine must be used carefully, (c) the tricyclic doxepine and the atypical nefazodone should better be avoided, and (d) lithium, usually considered as contraindicated, has been recently rehabilitated.
Division of Neonatology, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy. davanzor@burlo.trieste.it
Riccardo
R
Davanzo
Marco
M
Copertino
Angela
A
De Cunto
Federico
F
Minen
Alessandro
A
Amaddeo
D018759:Adrenergic Uptake Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000493:pharmacokinetics / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000493:pharmacokinetics / Q000627:therapeutic use; D001682:Biological Availability; D001942:Breast Feeding / Q000009:adverse effects*; D019052:Depression, Postpartum / Q000188:drug therapy* / Q000378:metabolism; D037001:Directive Counseling; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007774:Lactation / Q000378:metabolism; D018020:Lithium Compounds / Q000493:pharmacokinetics / Q000627:therapeutic use; D018811:Maternal Exposure / Q000009:adverse effects*; D008895:Milk, Human / Q000737:chemistry / Q000378:metabolism; D008996:Monoamine Oxidase Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use; D011247:Pregnancy; D017367:Selective Serotonin Reuptake Inhibitors / Q000493:pharmacokinetics / Q000627:therapeutic use
D018759:Adrenergic Uptake Inhibitors; D000928:Antidepressive Agents; D000929:Antidepressive Agents, Tricyclic; D018020:Lithium Compounds; D008996:Monoamine Oxidase Inhibitors; D017367:Selective Serotonin Reuptake Inhibitors