Antidepressants are one of the most commonly prescribed medications for pregnant and lactating women. However, there have been some recent concerns about their safety. This article summarizes recent research on the impact of untreated depression on the baby, the effects of antidepressants on the baby when prescribed during pregnancy, the short- and longer-term effects of prenatal exposure on infants and children, and the passage of medications into breast milk. Recommendations are made on providing mothers and their health care providers with information so they can make accurate risk/benefit analyses about using these medications while pregnant or breastfeeding.
Kendall-Tackett KANon-pharmacologic Treatments for Depression in New Mothers. Amarillo, TX: Hale Publishing; 2008.
2.
Hale TWMedications and Mothers’ Milk, 13th ed. Amarillo, TX: Hale Publishing; 2008.
3.
Newport DJ, Hostetter A., Arnold A., Stowe Z.The treatment of postpartum depression: minimizing infant exposures. J Clin Psychiatry. 2002; 63(Suppl 7):31-44.
4.
GlaxoSmithKline.Epidemiology study: paroxetine in the first trimester and the prevalence of congenital malformations; 2005.
5.
Einarson A., Pistelli A., DeSantis M., et al. Evaluation of the risk of congenital cardiovascular defects associated with use of paroxetine during pregnancy. Am J Psychiatry . 2008 June;165(6):749-752.
6.
Burt VK, Suri R., Altshuler L., Stowe Z., Hendrick VC, Muntean E.The use of psychotropic medications during breast-feeding. Am J Psychiatry. 2001;158:1001-1009.
7.
Field T.Breastfeeding and antidepressants. Infant Behav Dev. 2008;31:481-487.
8.
Freeman M.Perinatal psychiatry: risk factors, treatment data, and specific challenges for clinical researchers. J Clin Psychiatry. 2008;69: 633-634.
9.
American College of Obstetrics and Gynecology.Use of psychiatric medications during pregnancy and lactation . Obstet Gyn.2008;111: 1001-1020.
10.
Field T., Diego M., Hernandez-Reif M.Prenatal depression effects on the fetus and newborn: A review. Infant Behav Dev. 2006;29: 445-455.
11.
Dayan J., Creveuill C., Marks MN, et al. Prenatal depression, prenatal anxiety, and spontaneous preterm birth: a prospective cohort study among women with early regular care. Psychosom Med. 2006;68: 938-946.
12.
Patel V., Prince M.Maternal psychological morbidity and low birth weight in India. Br J Psychiatry. 2006;188:284-285.
13.
Field T., Diego M., Dieter J., et al. Prenatal depression effects on the fetus and the newborn. Infant Behav Dev. 2004;27:216-229.
14.
Field T., Hernandez-Reif M., Diego M., Figueiredo B., Schanberg S., Kuhn C.Prenatal cortisol, prematurity and low birth weight. Infant Behav Dev.2006;29:268-275.
15.
Orr ST, Reiter JP, Blazer DG, James SAMaternal prenatal anxiety and spontaneous birth in Baltimore, Maryland. Psychosom Med. 2007;69:566-570.
16.
Diego MA, Field T., Hernandez-Reif M.Prepartum, postpartum and chronic depression effects on neonatal behavior . Infant Behav Dev.2005;28:155-164.
17.
Cornish AM, McMahon CA, Ungerer JA, Barnett B., Kowalenko N., Tennant C.Postnatal depression and infant cognitive and motor development in the second postnatal year: the impact of depression chronicity and infant gender. Infant Behav Dev. 2005;28:407-417.
18.
Bugental DB, Beaulieu D., Schwartz A.Hormonal sensitivity of preterm versus full-term infants to the effects of maternal depression. Infant Behav Dev. 2008 ;31:51-61.
19.
Hendrick V. , Stowe ZN, Altshuler LL, Hwang S., Lee E., Haynes D.Placental passage of antidepressants medications . Am J Psychiatry. 2003;160:993-996.
20.
Oberlander TF, Grunau RE, Fitzgerald C., Papsdorf M., Rurak D., Riggs W.Pain reactivity in 2-month-old infants after prenatal and postnatal serotonin reuptake inhibitor medication exposure. Pediatrics. 2005;115:411-425.
21.
Loughhead AM , Fisher AD, Newport DJ, et al. Antidepressants in amniotic fluid: another route of fetal exposure. Am J Psychiatry. 2006;163:145-147.
22.
Oberlander TF, Warburton W., Misri S., Aghajanian J., Hertzman C.Neonatal outcomes after prenatal exposure to selective serotonin reuptake inhibitor antidepressants and maternal depression using population-based linked health data. Arch Gen Psychiatry . 2006;63:898-906.
23.
Kallen B.Neonate characteristics after maternal use of antidepressants in late pregnancy . Arch Pediatr Adolesc Med. 2004;158:312-316.
24.
Maschi S., Clavenna A., Campi R., Schiavetti B., Bernat M., Bonati M.Neonatal outcome following pregnancy exposure to antidepressants: a prospective controlled cohort study. BJOG. 2008;115:283-289.
25.
Louik C., Lin AE, Werler MM, Hernandez-Diaz S., Mitchell AAFirst-trimester use of selective serotonin-reuptake inhibitors and the risk of birth defects. N Engl J Med.2007;356:2675-2683.
26.
Spencer MJ, Escondido CAFluoxetine hydrochloride (Prozac) toxicity in a neonate. Pediatrics. 1993;92:721-722.
Oberlander TF, Misri S., Fitzgerald CE, Kostaras X., Rurak D., Riggs W.Pharmacologic factors associated with transient neonatal symptoms following prenatal psychotropic medication exposure. J Clin Psychiatry. 2004;65:230-237.
29.
Moses-Kolko EL, Bogen D., Perel JM, et al. Neonatal signs after late in utero exposure to serotonin reuptake inhibitors. JAMA. 2005;293: 2372-2383.
30.
Misri S., Reebye P., Kendrick K., et al. Internalizing behaviors in 4-year-old children exposed in utero to psychotropic medications. Am J Psychiatry. 2006;163:1026-1031.
31.
Oberlander TF, Reebye P., Misri S., Papsdorf M., Kim J., Grunau REExternalizing and attentional behaviors in children of depressed mothers treated with selective serotonin reuptake inhibitor antidepressant during pregnancy. Arch Ped Adolescent Med. 2007;161:22-29.
32.
Rampono J., Hackett LP, Kristensen JH, Kohan R., Page-Sharp M., Ilett KFTransfer of escitalopram and its metabolite demethylescitalopram into breastmilk . Br J Clin Pharmacol.2006;62:316-322.
33.
Melzer-Brody S., Payne JL, Rubinow D.Postpartum depression: what to tell patients who breast-feed. Curr Psychiatry. 2008;7:87-95.
34.
Stowe ZN, Owens MJ, Landry JC, et al. Sertraline and desmethylsertraline in human breast milk and nursing infants. Am J Psychiatry. 1997;154:1255-1260.
35.
Cipriani A. , Geddes JR, Furukawa TA, Barbui C.Metareview on short-term effectiveness and safety of antidepressants for depression: an evidence-based approach to inform clinical practice. Can J Psychiatry. 2007;52:553-562.
36.
Payne JLAntidepressant use in the postpartum period: practical considerations. Am J Psychiatry. 2007;164:1329-1332.
37.
Altshuler LL , Burt VK, McMullen M., Hendrick V.Breastfeeding and sertraline: a 24-hour analysis . J Clin Psychiatry. 1995;56:243-245.
38.
Kristensen JH, Ilett KF, Dusci LJ, et al. Distribution and excretion of sertraline and N-desmethylsertraline in human milk. Br J Clin Pharmacol . 1998;45:453-457.
39.
Stowe ZN, Owens MJ, Landry JC, et al. Sertraline and desmethylsertraline in human breast milk and nursing infants [see comments]. Am J Psychiatry. 1997;154:1255-1260.
40.
Stowe ZN, Cohen LS, Hostetter A., Ritchie JC, Owens MJ, Nemeroff CBParoxetine in human breast milk and nursing infants. Am J Psychiatry. 2000;157:185-189.
41.
Weissman AM , Levy BT, Hartz AJ, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004;161:1066-1078.
42.
Stowe ZN, Owens MJ, Landry JC, et al. Sertraline and desmethylsertraline in human breast milk and nursing infants. Am J Psychiatry. 1997;154:1255-1260.
43.
Epperson N. , Czarkowski KA, Ward-O’Brien D., et al. Maternal sertraline treatment and serotonin transport in breast-feeding mother-infant pairs. Am J Psychiatry. 2001;158:1631-1637.
44.
Begg EJ, Duffull SB, Saunders DA, et al. Paroxetine in human milk. Br J Clin Pharmacol . 1999;48:142-147.
45.
Spigset O., Carleborg L., Norstrom A., Sandlund M.Paroxetine level in breast milk. J Clin Psychiatry. 1996;57:39.
46.
Hale TW, Shum S., Grossberg M.Fluoxetine toxicity in a breastfed infant. Clin Pediatr . (Phila)2001;40:681-684.
47.
Lester BM, Cucca J., Andreozzi L., Flanagan P., Oh W.Possible association between fluoxetine hydrochloride and colic in an infant . J Am Acad Child Adolesc Psychiatry. 1993 ;32:1253-1255.
48.
Chambers CD , Anderson PO, Thomas RG, et al. Weight gain in infants breastfed by mothers who take fluoxetine. Pediatrics. 1999 ;104:e61.
49.
Weintrob N. , Cohen D., Klipper-Aurbach Y., Zadik Z., Dickerman Z.Decreased growth during therapy with selective serotonin reuptake inhibitors. Arch Pediatr Adolesc Med. 2002;156:696-701.
50.
Begg EJClinical Pharmacology Essentials : The Principles Behind the Prescribing Process . 2000; Auckland: Adis International.
51.
Ilett KF, Kristensen JH, Hackett LP, Paech M., Kohan R., Rampono J.Distribution of venlafaxine and its O-desmethyl metabolite in human milk and their effects in breastfed infants. Br J Clin Pharmacol. 2002;53:17-22.
52.
Ilett KF, Hackett LP, Dusci LJ, et al. Distribution and excretion of venlafaxine and O-desmethylvenlafaxine in human milk. Br J Clin Pharmacol. 1998;45:459-462.
53.
Weissman AM , Levy BT, Hartz AJ, et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004;161:1066-1078.
