Antidepressant medication for postpartum depression

Antidepressant medication can provide effective treatment for women with postpartum depression, including those who are breast-feeding. Your health professional may start you out with a low dose to help you adjust to the medication.

Selective serotonin reuptake inhibitors (SSRIs). An SSRI is usually the preferred medication for treating postpartum depression. Certain SSRIs are commonly prescribed for breast-feeding women and pose no known risks to their babies. SSRIs usually take 4 to 8 weeks to improve depression; postpartum women tend to improve sooner.¹

• Of the various SSRIs, sertraline (Zoloft) is usually the first-choice medication. It is most studied and generally does not seem to affect breast-feeding babies.²
• There have been reports of side effects in babies exposed to paroxetine (Paxil), fluoxetine (Prozac), and citalopram (Celexa).^{3, 4}
• Fluvoxamine (Luvox) has not been well studied.

Tricyclic antidepressants. Most tricyclics have not caused problems in breast-feeding babies and are not passed on to a breast-feeding baby in measurable amounts.^{3, 1} Nortriptyline has been studied the most for breast-feeding mothers.⁴ Doxepin (Adapin, Sinequan) is not recommended for breast-feeding mothers.

You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.

Antidepressants are used for at least 6 months, first to treat postpartum depression, and then to prevent a relapse of symptoms. Experts recommend long-term antidepressant treatment-up to a year-for women who have had three or more depressive episodes in the past.¹

FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:

• A warning on the antidepressants Paxil and Paxil CR (paroxetine) and birth defects. One new study showed that women who took Paxil during their first 12 weeks of pregnancy had a slightly higher chance of having a baby with birth defects.
• The U.S. Food and Drug Administration (FDA) has issued an advisory on antidepressant medicines and the risk of suicide. The FDA does not recommend that people stop using these medicines. Instead, a person taking antidepressants should be watched for warning signs of suicide. This is especially important at the beginning of treatment or when the doses are changed.

Citations

1. Wisner KL, et al. (2002). Postpartum depression. New England Journal of Medicine, 347(3): 194–199.

2. Whitby DH, Smith KM (2005). The use of tricyclic antidepressants and selective serotonin reuptake inhibitors in women who are breastfeeding. Pharmacotherapy, 25(3): 411–425.

3. Brockingham I (2004). Postpartum psychiatric disorders. Lancet, 363(9405): 303–310.

4. Weissman AM, et al. (2004). Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. American Journal of Psychiatry, 161: 1066–1078.