Antidepressants and Breastfeeding: A Mother's Decision
"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.
"That suggestion is very likely to intensify the anxiety and guilt that many of these mothers experience as a part of their depression," she tells WebMD. Stotland is a professor of psychiatry and obstetrics and gynecology at Rush Medical College in Chicago.
Resolution of the ambiguity around breastfeeding while on psychiatric medication would appear to await greater scientific understanding of the importance of trace elements and their connection to infant behavior.
But for Dede Adams, there was little ambiguity about her determination to breastfeed while she was still taking medication to treat her depression. "I feel very strongly about breastfeeding," Adams tells WebMD. "It was something I wanted to do. Breastfeeding is such an incredible bond. It's a sit-still time when you can just focus on your baby."