Psychiatric Medications and Breastfeeding: References

July 28, 2011. Posted in: Medications & Vaccines

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Using Antidepressants in Breastfeeding Mothers Info from an October 2002 conference session by Dr. Thomas Hale

@ other websites

Websites | Articles/Research | Specific Medications

Websites

Breastfeeding Pharmacology is the web site of Thomas Hale, Ph.D. Dr. Hale is a renowned Breastfeeding Pharmacologist and the author of Medications and Mothers’ Milk.

Western Australia Drugs in Human Milk Research Group. Ken Ilett, BPharm, PhD, an internationally known Breastfeeding Pharmacologist, heads up this group.

Breastfeeding and Psychiatric Medications from Massachusetts General Hospital Center for Women’s Mental Health

Breastfeeding and Antidepressants from AskDrSears.com

Mood Stabilizers: An Updated List and Links from PsychEducation.org

See Medications and Breastfeeding: References (@ ) for additional resources

Articles & Research

Whitby DH, Smith KM. The use of tricyclic antidepressants and selective serotonin reuptake inhibitors in women who are breastfeeding. Pharmacotherapy. 2005 Mar;25(3):411-25.

Einarson A. The Safety of Psychotropic Drug Use During Pregnancy: A Review. Medscape General Medicine 7(4):, 2005. (Note that this is for pregnancy and not lactation.)

Rubin ET, Lee A, Ito S. [PDF] When breastfeeding mothers need CNS-acting drugs. Can J Clin Pharmacol. 2004 Fall;11(2):e257-66. Epub 2004 Dec 8.

Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, Wisner KL. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004 Jun;161(6):1066-78.

Gjerdingen D. The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract. 2003 Sep-Oct;16(5):372-82.

Hendrick V, Smith LM, Hwang S, Altshuler LL, Haynes D. Weight gain in breastfed infants of mothers taking antidepressant medications. J Clin Psychiatry. 2003 Apr;64(4):410-2.

Ilett KF. Drugs and Breastfeeding in the Perinatal Period (online PowerPoint presentation). from the 2002 meeting of the Australian Lactation Consultant Association.

Breastfeeding and maternal SSRI use: is it safe? (December 2002) by Lisa Stellwagen, MD

Breastfeeding and Anti-depressant Medication by Wendy Jones PhD, MRPharmS

Depression and Breastfeeding by Thomas W. Hale, PhD, from Mothering (Issue 111 March/April 2002). This is a sidebar to the article But Is It Safe for My Baby? Medications and Breastfeeding

Misri S, Kostaras X. Benefits and risks to mother and infant of drug treatment for postnatal depression. Drug Saf. 2002;25(13):903-11.

Ernst CL, Goldberg JF. PDF The reproductive safety profile of mood stabilizers, atypical antipsychotics, and broad-spectrum psychotropics. J Clin Psychiatry. 2002;63 Suppl 4:42-55.

Gardiner S and Begg E. Drug Safety in Lactation. Prescriber Update 2001 May; No.21:10-23.

Chaudron LH. When and how to use mood stabilizers during breastfeeding. Prim. Care Update Ob Gyns. 2000 May 1;7(3):113-117.

Chaudron LH, Jefferson JW. Mood stabilizers during breastfeeding: a review. J Clin Psychiatry. 2000 Feb;61(2):79-90.

Birnbaum CS, Cohen LS, Bailey JW, Grush LR, Robertson LM, Stowe ZN. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics. 1999 Jul;104(1):e11.

Specific Medications

Celexa/Citalopram

Journal Search: Citalopram and Breastfeeding

Berle JO, Steen VM, Aamo TO, Breilid H, Zahlsen K, Spigset O. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome p450 genotypes. J Clin Psychiatry. 2004 Sep;65(9):1228-34.

Lee A, Woo J, Ito S. Frequency of infant adverse events that are associated with citalopram use during breast-feeding. Am J Obstet Gynecol. 2004 Jan;190(1):218-21.

Rampono J, Kristensen JH, Hackett LP, Paech M, Kohan R, Ilett KF. Citalopram and demethylcitalopram in human milk; distribution, excretion and effects in breast fed infants. Br J Clin Pharmacol. 2000 Sep;50(3):263-8.

Schmidt K, Olesen OV, Jensen PN. Citalopram and breast-feeding: serum concentration and side effects in the infant. Biol Psychiatry. 2000 Jan 15;47(2):164-5.

Spigset O, Carieborg L, Ohman R, Norstrom A. Excretion of citalopram in breast milk. Br J Clin Pharmacol. 1997 Sep;44(3):295-8.

Jensen PN, Olesen OV, Bertelsen A, Linnet K. Citalopram and desmethylcitalopram concentrations in breast milk and in serum of mother and infant. Ther Drug Monit. 1997 Apr;19(2):236-9.

Effexor/Venlafaxine

Journal Search: Venlafaxine and Breastfeeding

Berle JO, Steen VM, Aamo TO, Breilid H, Zahlsen K, Spigset O. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome p450 genotypes. J Clin Psychiatry. 2004 Sep;65(9):1228-34.

Ilett KF, Kristensen JH, Hackett LP, Paech M, Kohan R, Rampono J. Distribution of venlafaxine and its O-desmethyl metabolite in human milk and their effects in breastfed infants. Br J Clin Pharmacol. 2002 Jan;53(1):17-22.

Fisher AA, Davis MW. Serotonin syndrome caused by selective serotonin reuptake-inhibitors-metoclopramide interaction. Ann Pharmacother. 2002 Jan;36(1):67-71.

Hendrick V, Altshuler L, Wertheimer A, Dunn WA. Venlafaxine and breast-feeding. Am J Psychiatry. 2001 Dec;158(12):2089-90.

Luvox/Fluvoxamine

Journal Search: Fluvoxamine and Breastfeeding

Kristensen JH, Hackett LP, Kohan R, Paech M, Ilett KF. The amount of fluvoxamine in milk is unlikely to be a cause of adverse effects in breastfed infants. J Hum Lact. 2002 May;18(2):139-43.

Hendrick V, Fukuchi A, Altshuler L, Widawski M, Wertheimer A, Brunhuber MV. Use of sertraline, paroxetine and fluvoxamine by nursing women. Br J Psychiatry. 2001 Aug;179:163-6.

Piontek CM, Wisner KL, Perel JM, Peindl KS. Serum fluvoxamine levels in breastfed infants. J Clin Psychiatry. 2001 Feb;62(2):111-3.

Arnold LM, Suckow RF, Lichtenstein PK. Fluvoxamine concentrations in breast milk and in maternal and infant sera. J Clin Psychopharmacol. 2000 Aug;20(4):491-3.

Hagg S, Granberg K, Carleborg L. Excretion of fluvoxamine into breast milk. Br J Clin Pharmacol. 2000 Mar;49(3):286-8.

Yoshida K, Smith B, Kumar RC. Fluvoxamine in breast-milk and infant development. Br J Clin Pharmacol. 1997 Aug;44(2):210-1.

Wright S, Dawling S, Ashford JJ. Excretion of fluvoxamine in breast milk. Br J Clin Pharmacol. 1991 Feb;31(2):209.

Paxil/Paroxetine

Journal Search: Paroxetine and Breastfeeding

Berle JO, Steen VM, Aamo TO, Breilid H, Zahlsen K, Spigset O. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome p450 genotypes. J Clin Psychiatry. 2004 Sep;65(9):1228-34.

Isbister GK, Dawson A, Whyte IM, Prior FH, Clancy C, Smith AJ. Neonatal paroxetine withdrawal syndrome or actually serotonin syndrome? Arch Dis Child Fetal Neonatal Ed. 2001 Sep;85(2):F145-8.

Hendrick V, Fukuchi A, Altshuler L, Widawski M, Wertheimer A, Brunhuber MV. Use of sertraline, paroxetine and fluvoxamine by nursing women. Br J Psychiatry. 2001 Aug;179:163-6.

Stiskal JA, Kulin N, Koren G, Ho T, Ito S. Neonatal paroxetine withdrawal syndrome. Arch Dis Child Fetal Neonatal Ed. 2001 Mar;84(2):F134-5.

Nordeng H, Bergsholm YK, Bohler E, Spigset O. The transfer of selective serotonin reuptake inhibitors to human milk. Tidsskr Nor Laegeforen. 2001 Jan 20;121(2):199-203.

Stowe ZN, Cohen LS, Hostetter A, Ritchie JC, Owens MJ, Nemeroff CB. Paroxetine in human breast milk and nursing infants. Am J Psychiatry. 2000 Feb;157(2):185-9.

Misri S, Kim J, Riggs KW, Kostaras X. Paroxetine levels in postpartum depressed women, breast milk, and infant serum. J Clin Psychiatry. 2000 Nov;61(11):828-32.

Ohman R, Hagg S, Carleborg L, Spigset O. Excretion of paroxetine into breast milk. J Clin Psychiatry. 1999 Aug;60(8):519-23.

Begg EJ, Duffull SB, Saunders DA, Buttimore RC, Ilett KF, Hackett LP, Yapp P, Wilson DA. Paroxetine in human milk. Br J Clin Pharmacol. 1999 Aug;48(2):142-7.

Spigset O, Carleborg L, Norstrom A, Sandlund M. Paroxetine level in breast milk. J Clin Psychiatry. 1996 Jan;57(1):39.

Prozac/Fluoxetine

Journal Search: Fluoxetine and Breastfeeding

Berle JO, Steen VM, Aamo TO, Breilid H, Zahlsen K, Spigset O. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome p450 genotypes. J Clin Psychiatry. 2004 Sep;65(9):1228-34.

Suri R, Stowe ZN, Hendrick V, Hostetter A, Widawski M, Altshuler LL. Estimates of nursing infant daily dose of fluoxetine through breast milk. Biol Psychiatry. 2002 Sep 1;52(5):446-51.

Hale TW, Shum S, Grossberg M. Fluoxetine toxicity in a breastfed infant. Clin Pediatr (Phila). 2001 Dec;40(12):681-4.

Hendrick V, Stowe ZN, Altshuler LL, Mintz J, Hwang S, Hostetter A, Suri R, Leight K, Fukuchi A. Fluoxetine and norfluoxetine concentrations in nursing infants and breast milk. Biol Psychiatry. 2001 Nov 15;50(10):775-82.

Michael A, Mayer C. Fluoxetine-induced anaesthesia of vagina and nipples. Br J Psychiatry. 2000 Mar;176:299.

Chambers CD, Anderson PO, Thomas RG, Dick LM, Felix RJ, Johnson KA, Jones KL. Weight gain in infants breastfed by mothers who take fluoxetine. Pediatrics. 1999 Nov;104(5):e61.

Kristensen JH, Ilett KF, Hackett LP, Yapp P, Paech M, Begg EJ. Distribution and excretion of fluoxetine and norfluoxetine in human milk. Br J Clin Pharmacol. 1999 Oct;48(4):521-7.

Yoshida K, Smith B, Craggs M, Kumar RC. Fluoxetine in breast-milk and developmental outcome of breast-fed infants. Br J Psychiatry. 1998 Feb;172:175-8.

Brent NB, Wisner KL. Fluoxetine and carbamazepine concentrations in a nursing mother/infant pair. Clin Pediatr (Phila). 1998 Jan;37(1):41-4.

Taddio A, Ito S, Koren G. Excretion of fluoxetine and its metabolite, norfluoxetine, in human breast milk. J Clin Pharmacol. 1996 Jan;36(1):42-7.

Lester BM, Cucca J, Andreozzi L, Flanagan P, Oh W. Possible association between fluoxetine hydrochloride and colic in an infant. J Am Acad Child Adolesc Psychiatry. 1993 Nov;32(6):1253-5.

Burch KJ, Wells BG. Fluoxetine/norfluoxetine concentrations in human milk. Pediatrics. 1992 Apr;89(4 Pt 1):676-7.

Isenberg KE. Excretion of fluoxetine in human breast milk. J Clin Psychiatry. 1990 Apr;51(4):169.

Remeron/Mirtazapine

Journal Search: Mirtazapine and Breastfeeding

Ilett KF, Hackett LP, Kristensen JH, Rampono J. Distribution and excretion of the novel antidepressant mirtazapine in human milk. International Lactation Consultants Meeting, Sydney, July 31-August 3, 2003.

See also: Case study of the excretion of the antidepressant mirtazapine (Avanza, Remeron) in breastmilk from the December 2002 Newsletter of the Western Australian Drugs in Human Milk Research Group.

Wellbutrin/Buproprion

Journal search: Bupropion and Breastfeeding

Chaudron LH, Schoenecker CJ. Bupropion and breastfeeding: a case of a possible infant seizure. J Clin Psychiatry. 2004 Jun;65(6):881-2.

Haas JS, Kaplan CP, Barenboim D, Jacob P, Benowitz NL. Bupropion in breast milk: an exposure assessment for potential treatment to prevent post-partum tobacco use. Tobacco Control 2004;13:52-56.

Baab SW, Peindl KS, Piontek CM, Wisner KL. Serum bupropion levels in 2 breastfeeding mother-infant pairs. J Clin Psychiatry. 2002 Oct;63(10):910-1.

Briggs GG, Samson JH, Ambrose PJ, Schroeder DH. Excretion of bupropion in breast milk. Ann Pharmacother. 1993 Apr;27(4):431-3.

Xanax/Alprazolam

Journal Search: Alprazolam and Breastfeeding

Maitra R, Menkes DB. Psychotropic drugs and lactation. N Z Med J. 1996 Jun 28;109(1024):217-8.

Oo CY, Kuhn RJ, Desai N, Wright CE, McNamara PJ. Pharmacokinetics in lactating women: prediction of alprazolam transfer into milk. Br J Clin Pharmacol. 1995 Sep;40(3):231-6.

Anderson PO, McGuire GG. Neonatal alprazolam withdrawal–possible effects of breast feeding. DICP. 1989 Jul-Aug;23(7-8):614.

Zoloft/Sertraline

Journal Search: Sertraline and Breastfeeding

Berle JO, Steen VM, Aamo TO, Breilid H, Zahlsen K, Spigset O. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome p450 genotypes. J Clin Psychiatry. 2004 Sep;65(9):1228-34.

Stowe ZN, Hostetter AL, Owens MJ, Ritchie JC, Sternberg K, Cohen LS, Nemeroff CB. The pharmacokinetics of sertraline excretion into human breast milk: determinants of infant serum concentrations. J Clin Psychiatry. 2003 Jan;64(1):73-80.

Epperson N, Czarkowski KA, Ward-O’Brien D, Weiss E, Gueorguieva R, Jatlow P, Anderson GM. Maternal sertraline treatment and serotonin transport in breast-feeding mother-infant pairs. Am J Psychiatry. 2001 Oct;158(10):1631-7.

Hendrick V, Fukuchi A, Altshuler L, Widawski M, Wertheimer A, Brunhuber MV. Use of sertraline, paroxetine and fluvoxamine by nursing women. Br J Psychiatry. 2001 Aug;179:163-6.

Kristensen JH, Ilett KF, Dusci LJ, Hackett LP, Yapp P, Wojnar-Horton RE, Roberts MJ, Paech M. Distribution and excretion of sertraline and N-desmethylsertraline in human milk. Br J Clin Pharmacol. 1998 May;45(5):453-7.

Stowe ZN, Owens MJ, Landry JC, Kilts CD, Ely T, Llewellyn A, Nemeroff CB. Sertraline and desmethylsertraline in human breast milk and nursing infants. Am J Psychiatry. 1997 Sep;154(9):1255-60.

Epperson CN, Anderson GM, McDougle CJ. Sertraline and breast-feeding. N Engl J Med. 1997 Apr 17;336(16):1189-90.

Mammen OK, Perel JM, Rudolph G, Foglia JP, Wheeler SB. Sertraline and norsertraline levels in three breastfed infants. J Clin Psychiatry. 1997 Mar;58(3):100-3.

Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996 Sep;153(9):1132-7.

Altshuler LL, Burt VK, McMullen M, Hendrick V. Breastfeeding and sertraline: a 24-hour analysis. J Clin Psychiatry. 1995 Jun;56(6):243-5.