SSRIs during breastfeeding: spotlight on milk-to-plasma ratio

@article{Gentile2007SSRIsDB,
  title={SSRIs during breastfeeding: spotlight on milk-to-plasma ratio},
  author={Salvatore Gentile and Aude Rossi and Cesario Bellantuono},
  journal={Archives of Women's Mental Health},
  year={2007},
  volume={10},
  pages={39-51}
}
SummaryObjective: To investigate the usefulness of the milk-to-plasma (M/P) ratio for assessing the risks for the breastfed infant associated with the maternal use of SSRIs.Data sources: Medline, Toxnet, Embase, Current Contents, and PsycInfo indexed articles from 1980 to September 2006.Study selection and data extraction: All studies reporting the M/P ratio in mothers taking SSRIs while breastfeeding or studies which such an information could be calculated from data reported in the article… Expand
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In accordance with the Breastfed Infant-Antidepressant Safety Index classification, sertraline and paroxetine should be considered as first-line medications in women who need to start antidepressant treatment during the postpartum period and wish to continue breastfeeding. Expand
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Studies are needed with larger samples to properly evaluate the short and long-term effects of antidepressants on infants exposed through breast milk, so that clinicians can create standard decisions regarding the treatment of postpartum depression, without putting infants at risk. Expand
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Women exposed to an SSRI during pregnancy appear to be at risk for poorer breastfeeding outcomes and may benefit from additional education and support. Expand
L'impiego dei farmaci antidepressivi nel puerperio
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TLDR
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TLDR
Current evidence suggests that, as a group, a preference of TCAs over SSRIs in early pregnancy is not justified, and there appears to be a small gain in safety if TCAs (with the exception of clomipramine) are used in late pregnancy. Expand
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  • S. Gentile
  • Medicine
  • Expert opinion on drug safety
  • 2015
TLDR
Any conclusion about what antidepressant should be considered the safest during pregnancy must be stated and read with great caution, because the risks associated with pharmacological treatment must be balanced with the effects of untreated antenatal maternal depression on the mother-fetus dyad, which are likely to be devastating. Expand
Risks associated with in utero and lactation exposure to selective serotonin reuptake inhibitors (SSRIs).
TLDR
There is no conclusive evidence for increased risk for malformations but paroxetine and possibly fluoxetines use in early pregnancy may be associated with a small increased risk with regard to cardiovascularmalformations. Expand
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Measured M/P and estimated infant dose were similar in the two studies, although the range was wider for the single point study. Expand
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There was no significant correlation between the empiric m/p ratios and the predicted values using the Atkinson's model and there is no appropriate model to predict milk concentrations of drugs in humans. Expand
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Limited data support the prescription of fluvoxamine to breastfeeding mothers after a careful, individual risk/benefit analysis is undertaken and no adverse effects were detected by the mother or on clinical examination. Expand
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The study indicates that the relative dose to a suckling infant for paroxetine is lower than that reported for fluoxetines and citalopram and higher than that reporting for sertraline and fluvoxamine. Expand
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The lowest possible effective serum concentration should be used and breast-feeding during the drug absorption phase may be avoided and the amount of citalopram and other selective serotonin inhibitors (SSRIs) passed to breast milk and delivered to the child correlates to the serum concentration of the mother. Expand
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Irrespective of the method of calculation of infant exposure, the mean total dose of sertraline and its N-desmethyl metabolite transmitted to infants via breast-feeding is low and unlikely to cause any significant adverse effects. Expand
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