Szoptatás Portál ... naprakész információk a szoptatásról

Depresszió diagnosztizálása után gyakran javasolják a szoptató édesanyáknak, hogy válasszák el a babát. Vannak esetek, amikor ez lehet a legjobb megoldás, ám legtöbbször nincs rá szükség, mivel a depresszió szinte összes gyógymódja összeegyeztethető a szoptatással.

Hale TW, Kendall-Tackett K, Cong Z, Votta R, McCurdy F.
Breastfeed Med. 2010 Dec;5(6):283-8.

Abstract

OBJECTIVEThis study compared mothers' report of symptoms of discontinuation syndrome in infants exposed to antidepressants both in utero and during lactation to infants who were exposed only during lactation.

STUDY DESIGN: This is a convenience sample of 930 women breastfeeding women who answered an online questionnaire about antidepressant use while pregnant and breastfeeding. All 930 women had taken antidepressants while breastfeeding, and 527 had also taken antidepressants during pregnancy. There were no participants in the present study who had taken antidepressants only during pregnancy. The questionnaire was posted on the first author's Medications and Breastfeeding Forum. There was no advertising of this study, nor were efforts made to recruit women into this study beyond posting a notice on the website. The questionnaire included a list of symptoms that mothers may have observed in their infants during the newborn period, as well as demographic questions, and questions about antidepressant use during pregnancy and lactation.

Kendall-Tackett K, Hale TW.
J Hum Lact. 2010 May;26(2):187-95.

Abstract

Antidepressants are one of the most commonly prescribed medications for pregnant and lactating women. However, there have been some recent concerns about their safety. This article summarizes recent research on the impact of untreated depression on the baby, the effects of antidepressants on the baby when prescribed during pregnancy, the short- and longer-term effects of prenatal exposure on infants and children, and the passage of medications into breast milk.

Aaron M. Marshall, Laurie A. Nommsen-Rivers, Laura L. Hernandez, Kathryn G. Dewey, Caroline J. Chantry, Karen A. Gregerson and Nelson D. Horseman
J Clin Endocrinol Metab. 2010 Feb;95(2):837-46.

Abstract

Context: Serotonin [5-hydroxytryptamine (5-HT)] is an important local regulator of lactation homeostasis; however, the roles for the serotonin reuptake transporter and monoamine oxidase have not been known.

Objective: The aim of the study was to determine whether drugs that impact 5-HT affect human lactation physiology.

Adam Slevin
Physician Assistants Vol. 15; Issue 3; Page 33

New mothers who develop postpartum depression and who want to breastfeed their infants present a treatment challenge. SSRIs may be a safe and effective option for mother and child alike.

D. Jeffrey Newport, Page B. Pennell, Martha R. Calamaras, James C. Ritchie, Melanee Newman, Bettina Knight, Adele C. Viguera, Joyce Liporace and Zachary N. Stowe

PEDIATRICS Vol. 122 No. 1 July 2008, pp. e223-e231

Abstract

OBJECTIVE. Although lamotrigine use during pregnancy has substantially increased over the past decade secondary to accumulated reproductive safety data, systematic data on lamotrigine during breastfeeding remains sparse. We sought to characterize the determinants of lamotrigine concentrations in breast milk and nursing-infant plasma.

The Academy of Breastfeeding Medicine Protocol Committee

Breastfeeding Medicine, Volume 3, Number 1, 2008

Background

With estimates of between 5% and 25% of women experiencing depression in the postpartum year, it is critical that healthcare providers consider all treatment options, including the risks and benefits for nursing mothers.

Gentile, Salvatore

Drug Safety. 30(2):107-121, 2007.

Abstract:

Despite the well known severe repercussions of maternal depression on infants' well being, women are often reluctant to seek pharmacological treatment for postnatal depression. The fear of adverse events for the suckling infant plays an important role in such maternal considerations. However, the pharmacological approach to mood disorders at postpartum onset often represents one of the most realistic options in a number of clinical conditions. Therefore, the necessity exists to establish the safety of antidepressant treatment in the breastfed infant. For this reason, the aim of this article is to propose a specific safety index that assesses the frequency and degree of severity of adverse events in infants associated with maternal treatment with second-generation antidepressants during puerperium.

CLAUDIA M. KLIER, M.D., NILUFAR MOSSAHEB, M.D., AMY LEE, M.Sc., GERALD ZERNIG, M.D.

Am J Psychiatry 164:348-a-349, February 2007

To the Editor: Selective serotonin reuptake inhibitors are the most studied antidepressants in breastfeeding mothers (1). However, to date, there is only one case report regarding mirtazapine and breastfeeding (2). This study found no clinically significant levels of mirtazapine in the milk, and serum concentrations in the infant were below therapeutic concentration. Breastmilk levels, assessed 15 and 22 hours postdose, were higher in hindmilk compared with foremilk. A fully breastfed infant would ingest 0.21%–1.02% of the weight-adjusted maternal dose on a daily basis, suggesting minimal exposure of mirtazapine to the infant.

Kristensen JH, Ilett KF, Rampono J, Kohan R, Hackett LP.
Br J Clin Pharmacol. 2007 Mar;63(3):322-7. Epub 2006 Sep 13.

Abstract

What is already known about this subject

• There is presently only a single case report on mirtazapine transfer into breast milk and its effects in the breast-fed infant.

What this study adds

• Most importantly, we have provided quantitative data on the absolute and relative infant doses of mirtazapine and its active metabolite.
• We have also documented a lack of overt adverse effects in the breast-fed infants and low or absent plasma concentrations of mirtazapine in a subset of these infants.
• Hence we now know that breast-fed infants are unlikely to be adversely affected when their mothers need to take mirtazapine.

Aims To investigate the transfer of mirtazapine and desmethylmirtazapine into milk and to calculate dose to the infant via milk.

Rampono J, Hackett LP, Kristensen JH, Kohan R, Page-Sharp M, Ilett KF.
Br J Clin Pharmacol. 2006 Sep;62(3):316-22.

Abstract

Aims To investigate the transfer of escitalopram and its demethyl metabolite into milk, the absolute and relative infant doses via milk and to assess any unwanted effects in the breastfed infant.

Hackett LP, Ilett KF, Rampono J, Kristensen JH, Kohan R.
Eur J Clin Pharmacol. 2006 Aug;62(8):633-8. Epub 2006 May 13.

Abstract

Objective To investigate the transfer of reboxetine into milk, the absolute and relative infant doses via milk and to assess plasma concentrations and adverse unwanted effects in the breastfed infant.

Evelyn T. Rubin, Amy Lee, Shinya Ito

Can J Clin Pharmacol Vol 11(2) Fall 2004: e257-e266;

ABSTRACT

Background Breastfeeding is the ideal method of infant nutrition. However, if mothers need medications such as the central nervous system (CNS) acting drugs, infant safety concerns arise. Summarized information on infant exposure levels to drugs in milk and associated side effect profiles will help clinicians to rationalize and justify important drug therapy for a breastfeeding patient.

Dale H. Whitby, Pharm.D.; Kelly M. Smith, Pharm.D.

(Pharmacotherapy: Official Journal of the American College of Clinical Pharmacy)

Abstract

Postpartum depression is a well-recognized psychiatric condition that has gained increased attention over the past decade due to several nationally publicized tragedies. Medical management of this condition in women who are breastfeeding provides a unique challenge to health care professionals who may seek to maintain a fine balance between limiting the infant's exposure to hormone-altering drugs and maintaining the benefits of breastfeeding.

WOLFGANG AICHHORN, M.D., ALEXANDRA B. WHITWORTH, M.D., ULRIKE WEISS, M.D., and CHRISTOPH STUPPAECK, M.D.
Innsbruck and Salzburg, Austria

Am J Psychiatry 161:2325, December 2004

(A mirtazapine Magyarországon Mirzaten, Mizapin és Remeron neveken van forgalomban.)

To the Editor: Postpartum depression occurs in approximately 10% of childbearing women, and for many of them, treatment with an antidepressant may be necessary. The benefit of breast-feeding for the infant and the mother is well established; clinicians are therefore asked to make a careful risk-benefit decision on the use of antidepressants. The literature on antidepressants and breast-feeding consists mainly of case series of selective serotonin reuptake inhibitors and tricyclics, whereas information on newer antidepressants is scarce (1). We describe what we believe to be the first reported data on mirtazapine treatment in a breast-feeding woman.