SSRIs Relatively Safe While Nursing

Roberta Friedman, PhD

Medscape Medical News 2003

May 20, 2003 (San Francisco) — Tests of five different selective serotonin reuptake inhibitors (SSRIs) show they do not enter a mother’s milk in significant amounts, so nursing women can safely take these medications to treat postpartum depression. Findings on 23 nursing women and their babies were reported here at the 156th annual meeting of the American Psychiatric Association.

Norwegian scientists presented a study in which they collected samples of milk from 23 women nursing their babies. The mothers were taking one of five commonly used SSRIs. One woman had twins, so blood from 24 babies in all were sampled, along with serum from their mothers.

“I think it’s pretty safe” for mothers to take these drugs and nurse, said lead investigator Jan Oystein Berle, MD, in an interview with Medscape.

Nine mothers were taking citalopram, and five each were taking sertraline or paroxetine. Three were taking venlafaxine, and one was taking fluoxetine.

Milk drug levels were the mean of eight samples, which mothers provided both from the initial milk on nursing, and from residual milk after nursing. Blood was sampled from the babies by heel stick and other methods, said Dr. Berle, a research fellow in the Center for Child and Adolescent Psychiatry at the University of Bergen in Norway.

For sertraline and paroxetine, blood drug levels in babies were below the limit of detection. For citalopram, the babies on average showed 1.9 nmol/L. Fluoxetine and venlafaxine analysis yielded levels in babies of 47 and 91 nmol/L, respectively, but these levels included the active metabolites of these drugs.

Drug levels in babies ranged from zero to 10% of that in the mothers’ blood. The women took doses of 20 to 130 mg per day. Their serum drug levels fell within the therapeutic range, the researchers write in the poster.

Not only do these data support safe nursing, Dr. Berle said, but several studies also show that women who take these drugs while pregnant do not risk birth defects for their children.

Notably, one mother and her baby both turned out to be slow metabolizers, with the enzyme variant CYP2D6, the major enzyme involved in processing paroxetine. “This is what you would call the worst-case scenario,” Dr. Berle said, yet no trace of drug appeared in the child’s bloodstream.

The investigators could not find any specific behavioral or physical changes in the infants of mothers taking the antidepressants. For comparison, 68 nursed babies whose mothers did not take medications were measured and screened. They were of similar age, weight, length, sex ratio, and showed similar symptom scores.

The findings are good news for mothers who might be concerned about treating their depression during the early days of their babies’ lives. “Most of them want to” suckle their infants, said Roger Samuel, MD, who is in private practice in Boca Raton, Florida, and also carries out research.

“One way to get a depressed woman to connect with her child is to [have her] breast-feed.” And based on the study, Dr. Samuel told Medscape, “you can reasonably assure them it’s a good option.”

Roberta Lester-Britton specializes in treating women and new mothers.

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Dr. Gnap

Dr. Gnap is a family practice physician and behavioral medicine specialist in suburban Chicago.  Dr. Gnap developed the Inner Control™ Program in 1970 and has worked with thousands of people to improve and correct medical, emotional, behavioral and learning problems including performance.  He started the Inner Control program because so many patients asked, “what more can be done along with traditional treatment methods?”

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