Postpartum depression is classified as a major depressive
disorder, and the causes are not well known. Postpartum depression affects
approximately 14.5% of women, and it can affect both mother and infant.
Therefore, rapid attention and treatment are imperative. The causes of
postpartum depression are not well known; but there are many factors that may
increase the risk of developing the disease. Women should be carefully
evaluated after childbirth for depressive or anxiety symptoms with adequate
screening tools and methods to avoid diagnostic errors; especially when dealing
with women who present risk factors. The pharmacological approach often
represents one of the most realistic options for treatment. However, women may
be reluctant to take antidepressants because of the fear of adverse effects on
the infant, since most drugs pass into breast milk. The objective of this
review is to evaluate the risk-benefit of using antidepressants during
breastfeeding to treat postpartum depression.
An electronic search was performed by using the PubMed database
from January 2001 through December 2010. The search was limited to articles in
the English language and to articles that relate to human research. Manual
searches of bibliographies were also conducted to identify additional pertinent
studies.
The use of antidepressants that do not appear in infants’ plasma,
for which use during breastfeeding is better documented and at standard
therapeutic doses is recommended, such as sertraline and paroxetine. Fluoxetine
has a long half-life, which can lead to a long infant exposure through breast
milk, and citalopram can cause adverse effects in infants exposed through
breast milk. Therefore, citalopram and fluoxetine should not be used as
first-line treatments. If these drugs are used by a nurse, they should take the
lowest effective dosage, and their infants should be monitored.
This study focused on emphasising the importance of postpartum
depression treatment, always considering its repercussions for the breastfed
infants. 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.
Author
(s) Details
Leal,
Vânia
Pharmacy Department, Coimbra Health School, Polytechnic University
of Coimbra, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal.
Fonseca,
Ana Paula
Pharmacy Department, Coimbra Health School, Polytechnic University
of Coimbra, Rua 5 de Outubro, S. Martinho do Bispo, 3046-854 Coimbra, Portugal
and H&TRC - Health & Technology Research Center, Coimbra Health School,
Polytechnic University of Coimbra, S. Martinho do Bispo, 3046-854 Coimbra,
Portugal.
Please see the book here:- https://doi.org/10.9734/bpi/msraa/v5/5520
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