Weight Gain in Infants Breastfed by Mothers Who Take Fluoxetine

Chambers, Christina D.; Anderson, Philip O.; Thomas, Ronald G.; Dick, Lyn M.; Felix, Robert J.; Johnson, Kathleen A.; Jones, Kenneth Lyons

doi:10.1542/peds.104.5.e61

Cited by 96 publications

(58 citation statements)

References 12 publications

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“…Não houve diferença entre as drogas em relação a ganho de peso aos 6 meses, e depressões maternas mais prolongadas foram preditoras de menor ganho de peso. Em outro estudo (Chambers et al, 1999), 26 filhos de mães que tomaram fluoxetina durante a gravidez e a lactação foram comparados a 38 filhos de mães que utilizaram fluoxetina apenas durante a gestação. Aos 6 meses, crianças expostas à fluoxetina na amamentação pesaram em média 392 g a menos, após controle para peso ao nascer e sexo.…”

Section: Antidepressivos Causam Efeitos Indesejáveis Na Criança?unclassified

“…Mesmo que a maioria dos lactentes não seja exposta a uma dose significativa de medicação, no momento, não é possível prever que fatores expõem o lactente a risco excessivo. É possível que aqueles que são expostos a níveis significativos sofram efeitos colaterais e ganhem menos peso que os não-expostos, embora a relevância clínica desse achado seja questionável (Chambers et al, 1999). Mais preocupante, e logisticamente difícil de ser estudada, é a possibilidade que a exposição a níveis significativos de antidepressivo cause alterações no desenvolvimento do sistema serotoninérgico que só venham a ser detectadas mais tarde, como o estudo de Oberlander et al (2005) nos alerta.…”

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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Section: Antidepressivos Causam Efeitos Indesejáveis Na Criança?unclassified

Section: Conclusãounclassified

Questões críticas para o tratamento farmacológico da depressão pós-parto

Magalhães¹,

Pinheiro²,

Faria³

et al. 2006

Rev. psiquiatr. clín.

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“…But the general understanding is that although such infants may have gained less weight, they showed no clinical symptoms and did not have cognitive dysfunction when assessed with a standardised development scale (Yoshida et al, 1998;Chambers et al, 1999).…”

Section: Selective Serotonin Reuptake Inhibitorsmentioning

confidence: 99%

Psychotropic medication and breast-feeding

Kohen¹

2005

Adv. psychiatr. treat

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The physical and psychological benefits of breastfeeding for the mother and the infant are numerous and range from improved and stronger bonding to better immunological protection. Breast-fed infants have fewer episodes of middle-ear and urinary tract infections and lower mortality rates than bottle-fed babies (Nulman et al, 2003). Breast milk contains nucleotides and enzymes that promote digestion and absorption of nutrients. Breast-feeding has been associated with better cognitive functioning and better performance on IQ measures at age 7-8 years (Fergusson et al, 1982;Lucas et al, 1992).For the mother, breast-feeding causes oxytocin and prolactin release, precipitates postnatal uterine involution and suppresses ovulatory cycles.Breast-feeding has been successfully promoted in recent decades and a significantly large group of women now believe in its benefits and enquire about the possibilities of breast-feeding even when they are on psychotropic medication. It is the duty of the prescribing psychiatrist to guide the mother, the carers, the community mental health team, the general practitioner (GP), the obstetricians and the paediatricians through the intricacies of this complex area of psychopharmacology, in which there is an increasing interest but only scant research, few case studies and limited publications. Pharmacokinetics of psychotropics in breast milkResearchers need information on four factors in order to understand problems related to breastfeeding by mothers taking psychotropic medication: the prescribed dose; the level of the drug in the mother's blood plasma; the level in the breast milk; and the levels in the infant's serum. The amount of drug excreted in the milk is important in evaluating any drug-induced toxicity in the infant.The medication's diffusion across membranes, its molecular weight and its lipophilicity each play an important role in determining the amount that enters the breast milk (Nulman et al, 2003).The milk that comes out towards the end of a feed (hind milk) has a higher concentration of lipids than the thinner foremilk. Consequently, hind milk will contain a greater concentration of any lipid-soluble drug. Colostrum, produced only during the first few days after birth, has a higher protein level and will therefore contain a greater concentration of proteinbound drugs.To evaluate infant exposure to a drug the concentration of the medication or its metabolite are measured simultaneously in the mother's plasma and breast milk. A milk/plasma ratio greater than 1 Psychotropic medication and breast-feeding Dora KohenAbstract Adverse effects of psychotropic medication on breast-fed infants have not been studied in controlled and systematic research. Existing information comes from small case series and single case reports. These limited data confirm that psychotropics are excreted into breast milk and that the infant is exposed to them. In recent decades sufficient data have accumulated to allow psychiatrists to prescribe tricyclic antidepressants, selective serotonin reuptake in...

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“…Adverse clinical outcomes were also seen in 1 infant exposed to citalopram, 24 2 infants exposed to doxepin, 58,60 1 infant exposed to nefazodone, 68 and infants from 3 additional studies with fluoxetine. 27,29,31 The largest fluoxetine study compared 64 fluoxetine-treated mother-infant pairs with 38 non-treated motherinfant pairs. Statistically significant reductions in infant weight were seen in the fluoxetine group (average deficit, 392 g between 2 weeks and 6 months of age).…”

Section: Antidepressant Treatment In Breastfeeding Mothersmentioning

confidence: 99%

“…Statistically significant reductions in infant weight were seen in the fluoxetine group (average deficit, 392 g between 2 weeks and 6 months of age). 29 Given the various concerns regarding antidepressant treatment for breastfeeding women, the US Food and Drug Administration has not approved any antidepressant for use during lactation. 47 These studies provide helpful clinical information about antidepressant transmission to nursing infants, but their methodological weaknesses must also be considered.…”

Section: Antidepressant Treatment In Breastfeeding Mothersmentioning

confidence: 99%

The Effectiveness of Various Postpartum Depression Treatments and the Impact of Antidepressant Drugs on Nursing Infants

Gjerdingen¹

2003

The Journal of the American Board of Family Medicine

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Background: Postpartum depression is seen in approximately 13% of women who have recently given birth; unfortunately, it often remains untreated. Important causes for undertreatment of this disorder are providers' and patients' lack of information about the effectiveness of various treatments, and their concerns about the impact of treatment on nursing infants. This article presents research-based evidence on the benefits of various treatments for postpartum depression and their potential risks to nursing infants.Methods: The medical literature on postpartum depression treatment was reviewed by searching MEDLINE and Current Contents using such key terms as "postpartum depression," "treatment," "therapy," "psychotherapy," and "breastfeeding.

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Weight Gain in Infants Breastfed by Mothers Who Take Fluoxetine

Cited by 96 publications

References 12 publications

Questões críticas para o tratamento farmacológico da depressão pós-parto

Questões críticas para o tratamento farmacológico da depressão pós-parto

Psychotropic medication and breast-feeding

The Effectiveness of Various Postpartum Depression Treatments and the Impact of Antidepressant Drugs on Nursing Infants

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