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David Baxter

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What is the optimal management of depression [& anxiety] in a breastfeeding mother?
Saturday, 2-Dec-2006

Postnatal depression may occur in 10-15% of mothers. With careful selection of the antidepressant and regimen and with infant monitoring, it is seldom necessary to deny the healthy, full term infant the known benefits of breastfeeding.

Choice of class of agent should be made on clinical grounds and choice within the class will depend on physicochemical and pharmacokinetic parameters and side effect profile of the drug.

The following needs to be considered:

  • The lowest effective dose should be used for the shortest possible time.
  • Exposure of premature infants or those with compromised respiratory function to antidepressants via breast milk should be avoided.
  • Elimination half-life of drugs may be prolonged in the neonatal period, increasing the risk of drug accumulation on prolonged exposure.
  • For tricyclic antidepressants, imipramine or nortriptyline are preferred.
  • For SSRI antidepressants, fluvoxamine, paroxetine or sertraline are preferred.
  • Infants should be monitored for sedation, respiratory depression, weight gain and developmental milestones.
  • Co-administration of sedating agents should be avoided.

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