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Antidepressants and breastfeeding

(8 Posts)
francesrivis Mon 05-Oct-09 13:28:55

Hello, just wondering if anyone can help me. Don't know if anyone else saw Oliver James's column on PND in the Guardian family section on Saturday? He stated that the use of antidepressants by mothers with PND "rules out breastfeeding". I have e-mailed him stating that this is not the case and explaining my concern that comments like this could lead mothers to stop bfing or to stop taking medication which may be much needed. He has got back to me today asking which ADs have been cleared by NICE as OK for bfing mums and whether there are any longitudinal studies showing no harm caused to the children of these mums. I have pointed out to him that, while important, these questions do not change the fact that his statement is incorrect - he may think that ADs SHOULD rule out bfing, but I am testament to the fact that they don't, as are many other women! Nevertheless I would like to be able to answer his questions and wondered if anyone on here might have a better idea than me? (also wanted to have a rant - thanks for listening!)

tiktok Mon 05-Oct-09 13:45:23

I saw this, and good for you for contacting him.

NICE guidance on this is in the CG45 guidance on antenatal and postnatal mental health,page 10. The guidance does not say 'do not prescribe' and points out, sensibly, that all prescribing needs to be done with care.

"When choosing an antidepressant for pregnant or breastfeeding women,
prescribers should, while bearing in mind that the safety of these drugs is not well
understood, take into account that:
–tricyclic antidepressants, such as amitriptyline, imipramine and nortriptyline,
have lower known risks during pregnancy than other antidepressants
–most tricyclic antidepressants have a higher fatal toxicity index than selective
serotonin reuptake inhibitors (SSRIs)
–fluoxetine is the SSRI with the lowest known risk during pregnancy
–imipramine, nortriptyline and sertraline are present in breast milk at relatively
low levels
–citalopram and fluoxetine are present in breast milk at relatively high levels
–SSRIs taken after 20 weeks’ gestation may be associated with an increased risk
of persistent pulmonary hypertension in the neonate
–paroxetine taken in the first trimester may be associated with fetal heart defects
–venlafaxine may be associated with increased risk of high blood pressure
at high doses, higher toxicity in overdose than SSRIs and some tricyclic anti-
depressants, and increased difficulty in withdrawal
–all antidepressants carry the risk of withdrawal or toxicity in neonates; in most
cases the effects are mild and self-limiting. "

There is also guidance on the Royal College of Psychiatrists' site:

www.rcpsych.ac.uk/mentalhealthinformation/mentalhealthproblems/postnatalmentalhealth/postnataldepres sion.aspx

James is not a medical doctor and he should know to check anything he says about meds.

I was cross when I read this because I like his column.

francesrivis Mon 05-Oct-09 14:04:07

Thanks so much - good to know I am not alone in being annoyed by this! Will look at the link ASAP and get back to him

tiktok Mon 05-Oct-09 14:07:27

I've emailed him myself now, with yet another link...I hope he will correct what he said.

francesrivis Tue 06-Oct-09 14:22:18

Brilliant, many thanks! I have now had an apologetic e-mail from him - no doubt as a result of the info you provided. He didn't say he'd correct it though .... I did also e-mail the guardian corrections column, so maybe they will put something in.

tiktok Tue 06-Oct-09 14:43:27

I have been in email convo with him, and he accepts he was wrong...so we did a good job

Kudos to him for engaging with the issue.

I hope the Gdn prints a correction.

Tambajam Tue 06-Oct-09 14:48:51

Well done for saying something. This is definitely an issue that affects a lot of people and it would be awful if people gave up breastfeeding unnecessarily because of an error in such a widely read newspaper. He has a responsibility to ensure a correction is published.

weegiemum Tue 06-Oct-09 14:50:55

Oh this is good. I also emailed to correct as I have bf for a total of 4.5 years on sertraline, to no ill effect!

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