Article FYI - depression meds

http://www.obgynnews.com/article/PII...00149/fulltext
SAN FRANCISCO — All psychotropic medications are excreted into breast
milk, but the benefits of breast-feeding generally outweigh the
relatively small risks to the baby from antidepressants, Dr. Andrea J.
Singer said.
The nutritional advantages and the bonding that occurs between mother
and child during breast-feeding outweigh concerns about antidepressant
effects on the infant, she said at the Perspectives in Women's Health
conference sponsored by OB.GYN. NEWS.
The dose of antidepressant that the infant receives from the mother
during breast-feeding is much lower than the dose received in utero
because the drug crosses the placenta. If a mother and fetus have done
well on an antidepressant during pregnancy, stick with that therapy
after delivery. “The decision is easy—just continue,� said Dr. Singer,
director of women's primary care at Georgetown University Medical
Center, Washington.
SSRIs are first-line therapy for lactating women with depression
because they have the most data supporting safe use during
breast-feeding and efficacy in treating postpartum depression.
The aminoketone drug bupropion is a “not unreasonable alternative,� but
the amount of data on it is far more limited, she said.
Combining an SSRI with other supportive services is recommended for
severe postpartum depression. There is no consensus for treatment of
mild postpartum depression, Dr. Singer added. Consider psychotherapy
either alone or with an SSRI for mild depression in lactating women.
Dr. Singer is on the speakers' bureau of Pfizer, which makes the SSRI
sertraline.
Generally, sertraline is the treatment of choice for depressed
lactating women because of the amount of data available on its use. The
SSRIs paroxetine or fluvoxamine are first-line alternatives.
Second-line treatment choices include citalopram and fluoxetine. Start
with monotherapy when possible, she advised.
The long-term impact of trace levels of antidepressants in infants is
unknown. Most SSRIs and bupropion are rated Pregnancy Category C by the
Food and Drug Administration. Tricyclic antidepressants fall in
Category C or D.
“Most of my psychiatric colleagues don't look at labels so much as the
amount of clinical trial data. There is far more experience with the
SSRIs, particularly sertraline,� she said.
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