Many data have been published in the past three to five years that have greatly advanced the treatment of depressive disorders in postpartum women who wish to breast-feed. According to Zachary N. Stowe, M.D., director of the Emory University Pregnancy and Post-Partum Mood Disorders Program, "We now have more breast-feeding data on antidepressants than any other class of medications in the PDR."

The data show that selective serotonin reuptake inhibitor (SSRI) therapy in breast-feeding moms is safe. "It all looks good." Stowe told Psychiatric News, "In fact, it all looks just like we should have thought it would." Stowe explained that because most antidepressants are fairly large, mostly protein-bound molecules, they would not be expected to show up in an infant’s serum.

In a study published by Stowe and his colleagues in the February issue of the American Journal of Psychiatry (AJP), the SSRI paroxetine (Paxil) was shown to be safe to prescribe to nursing mothers. The study looked at the presence of paroxetine in breast milk and in the serum of breast-fed infants. Although paroxetine is secreted in breast milk, in the 16 nursing infants followed in this study, no detectable levels of the drug were found in the infants’ serum. In addition, no adverse effects were noted in the infants by either their parents or pediatricians following the infants.

Stowe told Psychiatric News that he and Lee S. Cohen, M.D., also at Emory, have more data ready for publication with other antidepressants. Their data on sertraline (Zoloft) involved 24 breast-fed infants and showed no detectable level of the drug in the infants’ serum as well as no observable adverse effects. In addition, they have studied 42 breast-fed infants whose mothers were taking fluoxetine (Prozac). Again, no drug was detected in the infants’ serum, and no observable adverse effects were shown.

Other researchers, including Katherine L. Wisner, M.D., M.S., director of the Mood Disorders Program at Case Western Reserve University School of Medicine, have published parallel studies duplicating the Emory group’s results.

Stowe told Psychiatric News that clinicians should no longer have any pharmacologic reason to avoid prescribing SSRIs to breast-feeding moms.

According to Stowe, depression occurs in about 8 percent to 10 percent of pregnant and postpartum women. This rate is similar to the incidence of depression in the overall population of women. But because of the concern for not simply one patient, but two, researchers and physicians in general have been more concerned about this specific population.

Stowe told Psychiatric News that as far as antidepressants are concerned, the next step is "to develop a smart antidepressant. With our knowledge of the placenta as an organ that metabolizes, there is a way to develop an antidepressant that does not cross the placenta." This would eliminate medication concerns when treating pregnant women who are experiencing a depressive disorder.

Stowe and his colleagues at Emory have recently formed collaborative agreements with researchers at the University of California at Los Angeles and Harvard University to study anticonvulsants and the new antipsychotics.

"Many women are now becoming pregnant while on these medications," Stowe said, "and we simply don’t know yet exactly what the implications will be."

"A healthy mom does make a healthy baby," he continued. "The difficulty is in making, or keeping, the mom healthy while not harming the baby."