Sertraline and paroxetine may be somewhat safer for the infants of nursing mothers than other SSRI antidepressants, but generally there is far too little information to go on, reported two Italian medical researchers in Human Psychopharmacology: Clinical and Experimental.
The researchers examined all available studies of the impacts on infants when their nursing mothers were taking antidepressants. “Several studies have examined the extent of drug exposure that occurs to nursing infants whose mothers take SRIs,” stated the researchers. “However, the available literature is represented largely by case reports or studies with a small sample size. Moreover, methodological differences have limited the reliability of the data analysed in the studies reviewed.”
They also noted that, “Breast milk is notoriously a difficult matrix for psychotropic drug analysis because of its high protein and lipid concentrations, the variability of its composition throughout the postpartum period and the highly lipophilic nature of most (antidepressants)… Hence, there is still not a unanimous consensus on what is really the most reliable lactation safety index.”
The researchers also acknowledged “major concern” about how exposing infants to antidepressants through breast milk “could affect in the long term the infants’ neurodevelopment and/or behaviour,” and they found information about effects on cognitive development to be lacking.
“There is a need to improve clinical research in this field in order to increase the information on the long-term neonatal outcomes, particularly those related to the neuro-cognitive development, using standardized and objective assessments,” concluded the researchers. They suggested more clinical studies should be done and epidemiological data should be gathered from mothers. “Healthcare providers and nursing mothers should have updated and reliable information on this topic, in order to make informed risk-benefit decisions on the use of antidepressant treatment during breastfeeding.”
(Absract) (Full text) Serotonin reuptake inhibitors and breastfeeding: a systematic review (Orsolini, Laura and Bellantuono, Cesario. Human Psychopharmacology: Clinical and Experimental. January 9, 2015. DOI: 10.1002/hup.2451)