Mom's Antidepressants Are Safe for Nursing Infants

For some new mothers, their bundle of joy is overshadowed by depression and anxiety. They struggle with severe sadness, emptiness, fear - as well as shame and secrecy over these feelings.

It is fairly common for women to develop depressive symptoms in the days after delivery; the "postpartum blues" is usually the consequences of a number of various factors and is self-limiting.

Yet persistent or worsening depression after delivery, called postpartum depression, affects about one out of 10 new mothers within six months of delivery. Teens and women with a history of depression and women with previous postpartum depression are at a higher risk of developing postpartum depression.

A mother's depression affects their infant's development, research shows. When babies are exposed to a mother's depression for two months or more, they gain less weight compared with other babies, says Victoria Hendrick, MD, professor of psychiatry at the UCLA School of Medicine.

"There's such extensive literature about the potential negative impact of a mother's depression on her children," Hendrick tells WebMD. "They don't do as well in a variety of factors - scores on IQ tests later on. They don't have a secure attachment with their mother. As they grow up, they tend to show more aggressive behavior toward peers."

Breastfeeding itself is known to impart important health benefits for baby and mother. Mother's milk offers the baby so much protection - reducing risk of gastrointestinal, urinary, respiratory tract and ear infections, reducing diarrhea and risk of SIDS (sudden infant death syndrome), and protecting against allergies, diabetes, and obesity later in life.

Yet it's been controversial: Can a woman safely take antidepressants while breastfeeding? Does the drug get into breast milk? Is it safe for the baby?

These questions first arose in the 1980s, when SSRI (selective serotonin reuptake inhibitor) antidepressants debuted to treat this disorder - first Prozac, then Paxil, Zoloft, and others.

A group of La Leche League mothers -- adamant supporters of breastfeeding -- were the first to ask about the drugs' safety. "Doctors were telling them they had to stop breastfeeding if they were taking antidepressants, and they wanted evidence," says Katherine L. Wisner, MD, director of Women's Behavioral HealthCare at the University of Pittsburgh's Western Psychiatric Institute and Clinic.

Landmark Study Eases Mothers' Fears

Since then, Wisner and researchers at several top U.S. institutions have launched study after study investigating this issue. Earlier this year, Wisner published a landmark study -- analyzing two decades of research data.

Her conclusion: If a nursing mother is taking an antidepressant, "very, very small amounts of that drug will be passed to her baby," Wisner tells WebMD. "Often the amount is so small that it's below the level that a lab can detect."

The findings on specific drugs:

• Zoloft and Paxil. Based on all the studies' results, these are the "drugs of choice" for breastfeeding women, Wisner tells WebMD. Infants exposed to Paxil and Zoloft had undetectable levels of the antidepressant in their blood, she reports.
• Prozac. Infants exposed to Prozac appear to be at higher risk of developing elevated levels of drug in the blood, especially if mothers have taken the drug during pregnancy. These babies tend to be more nervous, irritable, and to have stomach upsets, Wisner notes.