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Maternal fluoxetine treatment inside postpartum p... [pediatrics. 2003] - pubmed - ncbi
AbstractOBJECTIVE:

Postpartum major depression, a frequently (10%) occurring complication of childbirth, adversely affects the mother's functioning, the mother-infant relationship, and also the child's subsequent development and propensity for later psychopathology. Although selective serotonin reuptake inhibitors (SSRIs) work well in treating postpartum depression, concerns have been raised regarding easy use in lactating women. Although plasma drug amounts of infants who are exposed to SSRIs through breast milk are low compared to those typically affecting patients, infant levels in most reports do look like at or close to the drugs' reported affinities (K(D)s) and IC(50)s for inhibition for the serotonin (5-hydroxytryptamine [5-HT]) transporter. The impact of central serotonin 5-HT modulation by SSRIs during critical periods of brain development is unknown. These concerns have led we to check whether exposure through breast milk includes a discernible influence on platelet 5-HT uptake. Taking advantage of the similarities between platelet and neuronal serotonin transporters, we previously used measurements of platelet 5-HT before and through maternal sertraline treatment to ascertain the amount of 5-HT transporter blockade in breastfed infants. We learned that infants have been encountered with sertraline through their mothers' breast milk experienced practically no change in platelet 5-HT levels, suggestive of minimal effects on peripheral and central 5-HT transporter blockade. Weighed against sertraline and a lot other SSRIs, fluoxetine and its particular active metabolite, norfluoxetine, have substantially longer plasma half-lives, and both compounds have been located in measurable quantities in plasma of nursing infants. Thus, to increase our previous operate in the therapy lamp, we measured platelet 5-HT levels and plasma drug levels in breastfeeding mother-infant pairs before and during maternal treatment with fluoxetine.

METHODS:

Maternal and infant transporter blockade was assessed by measurement of platelet 5-HT in 11 breastfeeding mother-infant pairs before 4 to 12 weeks of maternal fluoxetine (20-40 mg/d) treatment for postpartum depression. The study was authorized by the Human Investigation Committee of Yale University Med school, each mother (mean age: 34. 5yrs; standard deviation [SD]: 5. 3) gave written informed consent. Whole-blood 5-HT levels and plasma fluoxetine and norfluoxetine levels were dependant upon high-performance liquid chromatography.

RESULTS:

Five mothers were taking 20 mg of fluoxetine daily, 4 had to have 30 mg daily, and a couple were taking 40 mg daily. Mean infant age at the beginning of the investigation was 16. 8 (SD: 8. 8) weeks. All infants except 1 were <6 months of age and 4 were <3 months of age when their mothers began treatment. Six infants were breastfed exclusively; the remaining were breastfed between 3 and 8 times daily and were given supplemental feedings. Mean maternal postexposure 5-HT levels of 22. 9 ng/mL (SD: 12. 5) were markedly lower than mean preexposure (baseline) levels of 156. 6 ng/mL (SD: 71. 4; paired t = 6 buy wellbutrin online no prescription. 9, df = 10). In contrast, the mean infant pre- and postexposure 5-HT concentrations of 217. 1 (SD: 66. 5) and 229. 9 (SD: 83. 5) ng/mL, respectively, were similar (paired t = -0. 24, df = 10). However, the 1 infant with measurable plasma fluoxetine had a substantial decline in 5-HT to 40% of baseline buy nasonex online without a prescription. In samples obtained from the same infant 4 months later, plasma drug levels were undetectable (<1 ng/mL) and the platelet serotonin levels were no longer reduced (12% increase from baseline).

CONCLUSIONS:

The marked declines (to 9%-28% of baseline) in platelet 5-HT concentrations found in mothers have been addressed with the SSRI fluoxetine were comparable to those observed in our study of sertraline in breastfeeding along with previous studies. In contrast, basically 1 infant experienced minimum decline in whole-blood (platelet) 5-HT concentrations after contact fluoxetine through breast milk. The substantial drop in platelet 5-HT seen in 1 infant plus the coupling in this drop with measurable plasma fluoxetine leves drop with measurable plasma fluoxetine level raises some concern. Possible causes of the infant's measurable plasma fluoxetine level include his mother's high plasma drug level with the exceptional being breastfed exclusively. However, the observations could be coincidental, along with the infant experienced no discernible adverse effects. These data suggest that most infants will continue to breastfeed without experiencing meaningful modifications to platelet 5-HT transport while their mothers are helped by 20 to 40 mg of fluoxetine daily. Considering the limited data regarding occurrence and extent of SSRI exposure plus the uncertainties regarding the potential side effects of exposure, it's premature to propose treatment guidelines. Each of our advice to girls that are thinking of combining breastfeeding and SSRI treatment will weigh an array of factors, including seriousness of postpartum depression, any demonstrated preferential respond to a certain SSRI, plus the mother's deal with breastfeeding. Additional principals are was required to establish more definitively the regularity of physiologically meaningful infant SSRI exposure during breastfeeding and also to determine the behavioral consequences of such exposure.

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