Antidepressants and Breastfeeding
- October 4, 2019
Infant exposure to antidepressants via breast milk is generally low. Post-natal depression affects 10-15% of women and is often treated with antidepressants. The benefits of breastfeeding, and treating depression, usually outweigh any theoretical risk to the infant posed by antidepressants. It is seldom necessary to stop breastfeeding if an antidepressant is required.
Infant exposure to antidepressants via breast milk
All antidepressants transfer into milk to some degree. The extent of infant exposure depends on several factors: maternal exposure (plasma concentration), distribution of the antidepressant into milk, volume of milk ingested and infant clearance (which increases with age).
Drugs with a RID or infant plasma concentration (relative to maternal) below 10% are generally considered safe in breastfeeding. However, more caution is required if:
Infant exposure is lower for drugs with a low fractional oral bioavailability (F). This is because less of the drug ingested via milk reaches the infant’s systemic circulation.
Key prescribing points
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|Antidepressant||RID (%)||Infant plasma concentrations||Half-life + active metabolite (hours)||F||Infant monitoring|
|citalopram||up to 8||undetectable to up to10%||35||0.8||· sedation or irritability
· poor feeding
· weight gain
|escitalopram||up to 8||undetectable or low||30||0.8|
|fluoxetine||up to 15||variable – can be up to10%||96 + 360||0.9|
|paroxetine||up to 3||undetectable or low
|sertraline||up to 3||26||0.5|
|venlafaxine||up to 12||undetectable to up to 37%||5 + 11||<0.5|
|amitriptyline||up to 3||undetectable or low||15 + 30||0.5||As for SSRIs plus:
· urinary retention
|clomipramine||up to 3||undetectable or low||25 + 69||0.5|
|imipramine||up to 5||low||12 + 24||0.5|
|nortriptyline||up to 4||undetectable or low||30||0.6|
|moclobemide||up to 6||low||11||1||As for SSRIs plus:
|bupropion||up to 11||undetectable or low
|21 + 21||<0.5||As for SSRIs plus:
|mirtazapine||up to 7||30||0.5||As for SSRIs|