Breastfeeding offers numerous benefits for both mother and baby, but the use of antidepressants introduces considerations about the transfer of medication into breast milk and its effects on the infant.

The safety of antidepressants in breastfeeding can influence maternal decisions regarding treatment and infant feeding.

It is vital to discuss antidepressants and breastfeeding with your healthcare professional of GP.

Classes of Antidepressants

Selective Serotonin Reuptake Inhibitors (SSRIs)

• Fluoxetine (Prozac): Fluoxetine has a relatively long half-life and is present in breast milk at higher concentrations than other SSRIs. This can lead to higher infant exposure, but studies generally show it to be safe, with careful monitoring advised for irritability or feeding difficulties.
• Sertraline (Zoloft): Considered one of the safest SSRIs during breastfeeding due to low levels in breast milk and minimal infant side effects. It is often the preferred choice.
• Paroxetine (Paxil): Low levels in breast milk and minimal reported side effects in infants make it another preferred SSRI.
• Citalopram (Celexa) and Escitalopram (Lexapro): These have moderate transfer into breast milk. While generally safe, higher doses of citalopram may require monitoring for somnolence or poor feeding in infants.

Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)

• Venlafaxine (Effexor): It passes into breast milk and its metabolite can have higher exposure in the infant. Monitoring for side effects like irritability or poor feeding is recommended.
• Duloxetine (Cymbalta): Limited data, but early studies suggest low levels in breast milk with minimal infant exposure, though more research is needed.

Tricyclic Antidepressants (TCAs)

• Amitriptyline and Nortriptyline: These are present in breast milk at low levels and generally considered safe. Nortriptyline, in particular, is preferred due to lower sedation and fewer side effects.
• Clomipramine: Higher levels in breast milk suggest caution, and monitoring for signs of sedation or poor feeding in infants is advised.

Monoamine Oxidase Inhibitors (MAOIs)

• Phenelzine (Nardil): Very limited data and potential for serious side effects make MAOIs generally not recommended during breastfeeding.

Atypical Antidepressants

• Bupropion (Wellbutrin): Low to moderate levels in breast milk. Some reports of seizure risks in infants, though these are rare. Generally considered with caution.
• Mirtazapine (Remeron): Limited data but available studies show low transfer into breast milk. Some infants may experience sedation.

Research consistently shows that many commonly used antidepressants, particularly SSRIs like sertraline and paroxetine, are relatively safe during breastfeeding, with low levels of drug transfer into breast milk and minimal reported adverse effects in infants.

Babies exposed to antidepressants through breastfeeding should be monitored for adverse effects, including irritability, feeding difficulties, or sedation.

 Support and Guidance 

Consult with healthcare providers to weigh the risks and benefits of continuing antidepressants during breastfeeding.

Selecting antidepressants with the best safety profile for breastfeeding, such as sertraline or paroxetine, can minimise risks.

Adjusting doses and timing of medication intake to minimise infant exposure may also be considered.

For more information about the effects of antidepressants in breastfeeding, click here.