Re: anxiety and breast-feeding

From: Gail Waldby (gwaldby@willinet.net)
Tue Sep 2 20:39:10 2003


Richard, here is an old article: Am J Psychiatry. 1996 Sep;153(9):1132-7. Antidepressant treatment during breast-feeding. Wisner KL, Perel JM, Findling RL. Mood Disorders Program, Case Western Reserve, University School of Medicine, Cleveland, OH 44106, USA. OBJECTIVE: The primary purpose of this article is to review critically the literature about use of antidepressants during lactation. Strategies for the clinical management of depressed breast-feeding mothers are also suggested. METHOD: The authors conducted a computerized search of MEDLINE for articles. The review includes studies in which serum levels of drugs were obtained from nursing infants. RESULTS: Fifteen published reports were located that provided information for the following nine antidepressants: amitriptyline, nortriptyline, desipramine, clomipramine, doxepin, dothiepin, fluoxetine, sertraline, and bupropion. CONCLUSIONS: Amitriptyline, nortriptyline, desipramine, clomipramine, dothiepin, and sertraline were not found in quantifiable amounts in nurslings, and no adverse effects were reported. Therefore, these are the drugs of choice for breast-feeding women. Adverse effects were described in some young infants whose mothers had been treated with doxepin or fluoxetine during breast- feeding. The collective serum level data suggest that infants older than 10 weeks are at low risk for adverse effects of tricyclics, and there is no evidence of accumulation. Research needs include an expanded database of mother-baby serum levels, behavioral assessments of infants during nursing, and longitudinal developmental evaluation of nurslings. Prescription of an antidepressant for a breast-feeding woman is a case-specific risk-benefit decision. Publication Types: Review Review, Tutorial

PMID: 8780414 [PubMed - indexed for MEDLINE] On Tue, 2 Sep 2003 20:28:46 -0500, Richard Chudacoff, MD <rchudacoff@mylinuxisp.com> wrote:

> 25 yr. old gravida 0at 10 weeks estimated gestational age that takes
> Effexor
> XR for anxiety. She states that when she goes off this medicine she
> becomes
> very difficult to be around, and she wants to stay on some kind of
> anxiolytic medication while breast-feeding. All SSRIs, as well as BuSpar
> and Wellbutrin, are not recommended for breast-feeding. Does anyone have
> any ideas of which medication can be used safely in pregnancy for
> anxiety?
> I am planning on referring her for hypnotherapy.
>
> Richard Chudacoff, MD, FACOG
> Chudacoff Obstetrics & Gynecology, PLLC
> 15200 Southwest Freeway, #270
> Sugar Land, TX 77478
>
> Tel: 281-277-3900
> Fax: 281-277-3901
>
> rchudacoff@mylinuxisp.com
> Richard.Chudacoff@obgyn.net
>
> http://www.mdhub.com/281-277-3900
> http://www.chudacoffobgyn.yourmd.com
>
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--
Gail Waldby




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