Depression, antidepressants, anxiolytics and breastfeeding

Maternal depression, especially postpartum –which for some authors is the one that may happend in the first month after birth but, due to the difficulty of clearly recongnize it is admitted to happend up to the first 6 months-, is a relatively common disorder that can affect 10-15% of women who have given birth and especially if they are teenagers. Thyroid disorders can mimic depression, so the doctor usually tries to assess the the thyroid function with tests before diagnosing depression.

Depressed mood is very destructive and distressing for the person and is amplified by all the life changes that happen to women after giving birth. When untreated, it can be devastating for her, her child, her immediate family and for attachment and subsequent mother-child relationships. If the desire of the woman is brearsfeeding, it is counterproductive removing it arguing depression as an excuse: frustration, feelings of guilt and low self-esteem, very strong in a depression, will only increase.

Some non-drug psychotherapeutic treatments such as interpersonal therapy can be effective to treat depression.

Most antidepressants are effective in treating depression, be it postpartum or not. They are indicated in moderate and severe depression when no improvement is achieved with psychotherapy. Do not be afraid to use this medication even if the mother is breastfeeding since the vast majority of antidepressants are fully compatible with breastfeeding as also some anxiolytics are. There are more than enough published scientific papers that prove it.

This is due to the fact that, in general, there is no passing at all or passing of negligible quantities of these substances to milk and, thus, do not affect the infant. Some of them may also increase milk production.

Paroxetine and sertraline are the safest and the most reported ones in scientific literature, but either member of the antidepressants family (inhibitors of serotonin reuptake) are very safe: Citalopram, Escitalopram, Duloxetine, Fluoxetine and Fluvoxamine. Similarly, antidepressants from other pharmacological families such as venlafaxine, moclobemide, amitriptyline, amoxapine, clomipramine, imipramine and nortriptyline are compatible with breastfeeding.

To complement the treatment of depression, anxiolytics drugs are also used to reduce the depression anxiety symptoms. These are drugs belonging to the benzodiazepine family like diazepam or Valium. They have the problem that can give drowsiness and, going into breast milk, lull the infant. Hence, during the breastfeeding is best to use the drug known to pass to the milk in less proportion and not exceed the prescribed dose. The adviced anxiolytic with published experience use in nursing mothers is Lorazepam.

You and your doctor can check the updated literature references by clicking on the literatura associated to each product in the website www.e-lactancia.org.

If in doubt when your doctor prescribes something, you can ask in inquiries@apilam.org.

Dr. JM Paricio Talayero, pediatrician, Breastfeeding Committee of the Spanish Association of Pediatrics.