Pooled Analysis of Antidepressant Levels in Lactating Mothers, Breast Milk, and Nursing Infants

Weissman, Alicia M.; Levy, Barcey T.; Hartz, Arthur J.; Bentler, Suzanne E.; Donohue, Micca; Ellingrod, Vicki L.; Wisner, Katherine L.

doi:10.1176/appi.ajp.161.6.1066

Cited by 263 publications

(205 citation statements)

References 71 publications

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“…A systematic review indicates that plasma levels of the SSRIs paroxetine and sertraline and the TCA nortriptyline in breastfed infants levels are usually undetectable, whereas citalopram and fluoxetine produce infant plasma levels that are above 10% of the maternal plasma level in 22 and 17% of infants, respectively (Weissman et al 2004). In mothers receiving TCAs (with the exception of doxepine), it seems unwarranted to recommend that breast feeding should be discontinued.…”

Section: Breast Feedingmentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

699

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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Section: Breast Feedingmentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

699

410

View full text Add to dashboard Cite

show abstract

“…There is a growing literature regarding a neonatal syndrome and medical complications with late pregnancy antidepressant use (Moses-Kolko et al, 2005). Although the literature suggests low levels of antidepressant exposure through breastmilk, there have been case reports of suspected adverse events in breastfed babies and a lack of long-term safety data (Weissman et al, 2004).…”

Section: Introductionmentioning

confidence: 99%

Omega-3 fatty acids and supportive psychotherapy for perinatal depression: A randomized placebo-controlled study

Freeman

Davis

Sinha

et al. 2008

Journal of Affective Disorders

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168

136

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“…Uma metanálise recente ajuda a responder essa questão (Weissman et al, 2004). Por meio da síntese de 57 artigos publicados e dados previamente inéditos (total de 238 lactentes expostos a 15 antidepressivos diferentes), os autores encontraram níveis significativos de antidepressivo em maior proporção de crianças expostas a fluoxetina e citalopram; houve menor probabilidade de crianças expostas a nortriptilina, sertralina ou paroxetina desenvolverem níveis plasmáticos detectáveis ou elevados.…”

Section: Em Que Grau Os Antidepressivos São Encontrados No Leite Mateunclassified

“…Atualmente, há apenas relatos de caso mostrando possíveis efeitos colaterais em crianças cujos níveis séricos foram medidos, entre eles, irritabilidade, dificuldades com o sono e alimentação (Weissman et al, 2004). Um estudo com 25 mulheres que utilizavam ISRS e 68 controles, entretanto, não demonstrou excesso de efeitos adversos nos expostos (Berle et al, 2004).…”

Section: Antidepressivos Causam Efeitos Indesejáveis Na Criança?unclassified

“…Clinicamente, uma possibilidade é utilizar apenas antidepressivos que tenham menor probabilidade de acumulação nos lactentes, como a sertralina e a paroxetina (Weissman et al, 2004;Magalhães e Pinheiro, 2006), como endossado recentemente por um consenso entre especialistas (Altshuler et al, 2001). Entre os antidepressivos tricíclicos, a nortriptilina seria uma alternativa; inexistem, contudo, ensaios clínicos randomizados que avaliem o uso de qualquer tricíclico no pós-parto e, como explicitado anteriormente, há indicações que os ISRS sejam mais úteis no tratamento de mulheres jovens.…”

Section: Conclusãounclassified

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Questões críticas para o tratamento farmacológico da depressão pós-parto

Magalhães¹,

Pinheiro²,

Faria³

et al. 2006

Rev. psiquiatr. clín.

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Palavras-chave: Depressão pós-parto, tratamento medicamentoso, inibidores seletivos da recaptação da serotonina, amamentação, desenvolvimento infantil. AbstractContext: Postpartum depression (PPD) is a frequent complication of childbirth, with complexities in its clinical management. Objective: In this review article, we propose clinical questions which are relevant to the pharmacological treatment of PPD. Method: Searches were performed in MEDLINE, PsychInfo, CINAHL, Biological Abstracts, Lilacs and in the Cochrane Central Register of Controlled Trials. Results: Current treatment guidelines for the treatment of depression apply to women with PPD which are not breastfeeding. Significant antidepressant levels are more often detected in children exposed to fluoxetine or citalopram. In those who are exposed, untoward effects and reduced growth are possible. Conclusions: Until the impact of antidepressant exposure through breastfeeding is better understood, a possible clinical approach would be to prescribe antidepressants generally not detected in the infants' plasma, such as sertraline or paroxetine.

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Pooled Analysis of Antidepressant Levels in Lactating Mothers, Breast Milk, and Nursing Infants

Cited by 263 publications

References 71 publications

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Omega-3 fatty acids and supportive psychotherapy for perinatal depression: A randomized placebo-controlled study

Questões críticas para o tratamento farmacológico da depressão pós-parto

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