Pharmacological Treatment Of Postnatal Depression? • TCAs and SSRIs can both be used in breast feeding mothers. The choice of agent should be based on the individuals needs, with attention paid to available safety data and patient preference. At present,a greater amount of safety data is available for TCAs (largely because they have been available for longer) than for SSRIs. • For TCAs, the preferred choices are amitriptyline and imipramine, as they have the largest amount of safety data available. Method Of Administration • Use single daily dose of agent, at its lowest effective dose. • Administer dose immediately before infant’s longest sleep period. • Breast-feeding should take place immediately before the dose is given. • Avoid breast-feeding during peak drug levels. For very young infants feeding frequently, one bottle feed can be substituted to avoid peak drug levels at 1-3 hours dose. • Infants ahould be monitored for drowsiness or other behavioural changes. • Avoid abrupt withdrawal of agent. The use of antidepressants in breast-feeding mothers is a complex issue and it is always wise to seek further advice before commencing/changing treatment. Useful contacts include Salford PCT Prescribing Team, your Consultant Psychiatrist or Trent Drug Information Service (Drugs and Breast-feeding advice) on 0116 2555 779. If Breast-Feeding • All antidepressants are secreted in breast milk, but the (limited) available data suggest that plasma concentrations of TCAs and SRRIs in breast-feeding infants are rarely detectable on standard assays. • Provided that the baby is full-term and healthy, the evidence does not seem to warrant a recommendation that the mother stops breast-feeding while taking a TCA or (though less is known) SSRI in usual doses. • However, pre-term infants should not continue to be brest-fed, as there is a risk of drug accumulation due to reduced excretory function. If Not Breast-Feeding Please refer to Pharmacological Treatment of Depression Guidelines. Useful Patient Information Self-help book Harvey,E. The Element Guide to Postnatal Depression: Your Questions Answered.1999. Element (Publisher). ISBN 1-86204-330-2 Support organisations Meet A Mum Association (MAMA) -support to women suffering postnatal dpression HELPLINE: 020 8768 0123 National Childbirth Trust HELPLINE 0870 444 8707 Association for Postnatal Illness HELPLINE 0207 386 0868 Back