Antidepressants and Breastfeeding: A Mother's Decision
Nevertheless, "trace elements" of medication can be found in the blood of breastfed infants, and may vary according to the medication and the disorder that is being treated. And because there have been isolated reports of adverse events in breastfed infants that may be related to maternal antidepressant use, the decision remains clouded by a degree of scientific ambiguity.
A recent report in the American Journal of Psychiatry -- of which Stowe was a co-author -- suggests that decisions about using psychiatric medications while breastfeeding should be made on a case-by-case basis. And that decision should be made in the context of a range of factors, including not only information about possible side effects, but also consideration of the mother's commitment to breastfeeding.
"There are clear benefits to breastfeeding," Stowe tells WebMD. "If it's important to the woman, it should be their decision."
The study involved an extensive search of medical literature for reports on a wide range of medications used during breastfeeding. That search yielded none of the preferred controlled trials on the subject -- the kind of trials comparing adverse events in infants among mothers who used psychiatric medications during breastfeeding, and those who did not. What exists, instead, is a substantial body of smaller "case series" studies; these are published reports of patients who have used medication during breastfeeding.
Among the findings from the literature review was one showing 11 published reports of mothers using Prozac, involving 190 breastfed infants. Measurements of trace elements in infant blood varied, and no negative effects were noted in 180 of the 190 infants.
One case of an infant was reported in which blood levels of medication in the child were comparable to those in the mother. Negative effects included excessive crying, decreased sleep, vomiting, and diarrhea, which dissipated after discontinuation of breastfeeding.
Because of such reports, the authors of the study recommend that infants being breastfed by moms on antidepressant medication be actively monitored by a pediatrician.
But on that point, not all experts agree.
Psychiatrist Nada Stotland, MD, says that while trace elements are sometimes found, it would be all but impossible for a doctor to determine if they are related to any adverse events. And though she supports the authors' conclusions that decisions should be made on a case-by-case basis involving a host of factors, she is critical of the recommendation that pediatricians actively monitor infants.