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Use of Antidepressants to Treat Postpartum Depression, During Breast Feeding

Ana Paula Fonseca and Vania Leala

Postpartum depression affects approximately 14.5% of women and it can affect both mother and infant. Therefore, rapid attention and treatment are imperative. The pharmacological approach often represents one of the most realistic options of treatment. However, women may be reluctant to take antidepressants because of the fear of adverse effects for the infant, since that most drugs pass into breast milk. The use of pharmacotherapy has not been extensively documented in this population. The objective of this review is to evaluate the risk benefit of using antidepressants during breastfeeding to treat postpartum depression. An electronic search was performed by using PubMed database, from January 2001 through December 2010. The search was limited to articles in the English language and to articles that relate human’s research. Manual searches of bibliographies were also conducted to identify additional pertinent studies. The use of antidepressants that do not appear in infants’ plasma, for which use during breastfeeding is better documented and at standard therapeutic doses is recommended, such as sertraline and paroxetine. Fluoxetine has a long half-life which can lead to a long infant exposition through breast milk and citalopram can cause adverse effects in infants exposed through breast milk. Therefore, citalopram and fluoxetine should not be used as first-line treatments. More information is needed about the use of the other antidepressants referred in this study. This study aims to emphasize the importance of postpartum depression treatment, always considering its repercussions for the breastfed infants. Studies are needed with larger samples to properly evaluate the short and long-term effects of antidepressants on infants exposed through breast milk, so that clinicians can create standard decisions regarding the treatment of postpartum depression, without putting infants at risk.