Safety in Lactation: Antidepressants

Additional information relating to breastfeeding

To be used in conjunction with individual drug entries for specific information and guidance.

Monamine-oxidase inhibitors (MAOIs)

Due to the absence of data on use in lactation, and the potential for serious interactions with some foods and drugs, first generation MAOIs should not be used during lactation.

Moclobemide is not considered to be a first line antidepressant for use during lactation.

Selective serotonin reuptake inhibitors (SSRIs)

Paroxetine and sertraline are SSRIs of choice. Compared to other SSRIs they have shorter half-lives and lower passage into milk. Although fluoxetine has a significant amount of published evidence for use in breastfeeding, its very long half-life greatly increases the risk of accumulation in the breastfed infant; adverse reactions via breast milk are reported more often with fluoxetine than with other SSRIs.

All infants should be monitored for drowsiness, poor feeding, irritability/restlessness

Tricyclic and related antidepressant drugs

Because of concerns about maternal toxicity, tricyclics have been prescribed less often than SSRIs for post natal depression.

The less sedating agents imipramine and nortriptyline are preferred, if clinically appropriate. All infants should be monitored for drowsiness, poor feeding and irritability/behavioural effects.

Other antidepressants

None of the antidepressants is this group of miscellaneous antidepressants are considered to be first line for use during lactation. All infants should be monitored for drowsiness, poor feeding, irritability/behavioural effects.

AgomelatineAmitriptylineCitalopramClomipramineDosulepinDoxepinDuloxetineEscitalopramFluoxetineFlupentixolFlupentixol decanoateImipramineIsocarboxazidLofepramineMental health and illnessMianserinMirtazapineMoclobemideNortriptylineObstetrics and gynaecologyPaediatric and neonatal medicineParoxetinePhenelzineReboxetineSafety in LactationSertralineSt. John's wortTranylcypromineTrazodoneTrimipramineTryptophanVenlafaxineVortioxetine