Management of depression in breastfeeding mothers – are tricyclic antidepressants safe?

· West Midlands Medicines Information Service

  • Estimates of the amount of TCA ingested by an infant via breast milk are of the order of 0.2 – 4% of the weight adjusted maternal daily dose.
  • With the exception of doxepin, no adverse effects have been noted in breastfed infants exposed to tricyclic antidepressants via breast milk.
  • All tricyclic antidepressants, except doxepin, can safely be given to a woman who is breastfeeding, provided the infant is full term, healthy and his or her progress is monitored.
  • The non-sedating agents imipramine and nortriptyline are preferred, if clinically appropriate.
  • Use of other sedating agents in the mother should be avoided since sedation can be additive.
  • Infants should be monitored for drowsiness or other behavioural changes.