Depression, Treatment, and Breastfeeding
by Thomas W. Hale, PhD

While there has always been some controversy over the use of antidepressant medications in breastfeeding mothers, a new study confirms what we’ve all been suggesting for years, that it’s simply too risky for the infant not to treat a breastfeeding mother with depression. In a nicely done paper, McLearn et al. (2006) studied whether maternal depressive symptoms alter a mother’s parenting practices the first few months postpartum. In a total of 4874 mothers who completed their survey, 17.8% of the mothers reported having depressive symptoms. In this study, mothers with and without depression reported similar use of safety practices, but those who reported depression discontinued breastfeeding at a higher rate and reduced showing books, playing with the infant, talking to the infant, and following normal routines.

This confirms what we’ve thought for some time, that maternal depression leads to poor parenting and that parenting practices that require more active intervention with the infant may be selectively reduced.
The findings from this and other studies provide important implications for pediatric health care practitioners. First is the need for all pediatric health care practitioners to screen for depression in mothers with newborns. Screening for maternal depression falls within the scope of professional responsibility for pediatric physicians and this includes universal screening, guidance, and referral. Once maternal depression is identified, pediatric healthcare professionals simply must provide anticipatory guidance to these mothers to enhance their parenting ability as well as a referral for the mother to an appropriate healthcare professional to assist with the treatment of their depression.
Following more than a decade of use, the antidepressants have been largely found to be devoid of major complications in breastfeeding infants, with a few exceptions. While some side effects have been reported, most of these may have been neonatal withdrawal rather than true serotonin syndrome. While studies of long-term neurobehavioral outcome in these infants exposed to antidepressants via breastmilk have yet to be published, small studies and results of a recent survey of my own suggest that the outcome in these infants is going to be normal.
Thus we must be vigilant in seeking care for all mothers (formula or breastfeeding) who present with symptoms of depression and make sure that they are referred to proper resources to see to their depression. The failure to help these mothers will ultimately negatively impact their infants and our future.

Reference

1. Arch Pediatr Adolesc Med. 2006;160:279-284