From the Guidelines
Most SSRIs are generally considered safe to use during breastfeeding, though some caution is warranted. When considering the use of SSRIs during breastfeeding, it's essential to weigh the benefits of treating maternal depression against the potential risks to the infant. According to the most recent and highest quality study 1, sertraline (Zoloft) and paroxetine (Paxil) are often preferred options as they transfer minimally into breast milk.
Key Considerations
- Fluoxetine (Prozac) has a longer half-life and may accumulate in infants, making it less ideal 1.
- Escitalopram (Lexapro) and citalopram (Celexa) are also considered relatively safe but with slightly higher transfer rates 1.
- When taking SSRIs while breastfeeding, monitor your baby for unusual irritability, poor feeding, or sleep disturbances.
- The benefits of treating maternal depression often outweigh the minimal risks to the infant, as untreated depression can negatively impact mother-infant bonding and child development.
- Starting with the lowest effective dose is recommended.
- If you're already on an SSRI that's working well before pregnancy, continuing the same medication is often better than switching.
- Always discuss your specific situation with your healthcare provider, as individual factors like your medical history and the infant's health status should be considered when making this decision 1.
From the Research
Safety of SSRIs during Breastfeeding
- The use of Selective Serotonin Reuptake Inhibitors (SSRIs) during breastfeeding has been studied, and the results suggest that most newer antidepressants produce very low or undetectable plasma concentrations in nursing infants 2.
- Some SSRIs, such as fluoxetine, citalopram, and venlafaxine, have been reported to have higher infant plasma levels, and suspected adverse effects have been reported in a few infants, particularly for fluoxetine and citalopram 2.
- Paroxetine and sertraline are considered suitable first-line agents for breastfeeding mothers, as they are present in low levels in breast milk 2, 3, 4.
Risk-Benefit Assessment
- The risk-benefit balance assessment of SSRI antidepressant use during pregnancy and lactation suggests that SSRIs can still be considered as appropriate when effective, as the abundant data support their relative safety 5.
- However, an individual risk-benefit assessment should always be performed, taking into account the specific properties of the proposed medication, such as the relative infant dose and side effect profile 2, 3.
- The interpretation of the findings remains quite similar to previous reviews, as the available methodology does not allow to disentangle the potential effect of SSRIs from those of the disease itself or/and of its unmeasured associated risk factors 5.
Recommendations
- Sertraline and paroxetine show a better neonatal safety profile during breastfeeding as compared with other SSRIs, and are recommended as first-line choices in nursing women who need an antidepressant treatment 2, 3, 4.
- Monoamine oxidase inhibitors (MAOIs) should generally be avoided during breastfeeding due to the lack of safety data 3.
- Limited data are available about the long-term neurodevelopmental outcomes after SSRI exposure during pregnancy and lactation, but currently, cognitive development seems normal, while behavioural abnormalities may be increased 6.