Wisner K L, Perel J M, Findling R L
Mood Disorders Program, Case Western Reserve, University School of Medicine, Cleveland, OH 44106, USA.
Am J Psychiatry. 1996 Sep;153(9):1132-7. doi: 10.1176/ajp.153.9.1132.
The primary purpose of this article is to review critically the literature about use of antidepressants during lactation. Strategies for the clinical management of depressed breast-feeding mothers are also suggested.
The authors conducted a computerized search of MEDLINE for articles. The review includes studies in which serum levels of drugs were obtained from nursing infants.
Fifteen published reports were located that provided information for the following nine antidepressants: amitriptyline, nortriptyline, desipramine, clomipramine, doxepin, dothiepin, fluoxetine, sertraline, and bupropion.
Amitriptyline, nortriptyline, desipramine, clomipramine, dothiepin, and sertraline were not found in quantifiable amounts in nurslings, and no adverse effects were reported. Therefore, these are the drugs of choice for breast-feeding women. Adverse effects were described in some young infants whose mothers had been treated with doxepin or fluoxetine during breast-feeding. The collective serum level data suggest that infants older than 10 weeks are at low risk for adverse effects of tricyclics, and there is no evidence of accumulation. Research needs include an expanded database of mother-baby serum levels, behavioral assessments of infants during nursing, and longitudinal developmental evaluation of nurslings. Prescription of an antidepressant for a breast-feeding woman is a case-specific risk-benefit decision.
本文的主要目的是批判性地回顾有关哺乳期使用抗抑郁药的文献。还提出了对患有抑郁症的哺乳期母亲进行临床管理的策略。
作者对MEDLINE进行了计算机检索以查找相关文章。该综述包括从哺乳婴儿中获取药物血清水平的研究。
找到了15篇已发表的报告，这些报告提供了以下9种抗抑郁药的信息：阿米替林、去甲替林、地昔帕明、氯米帕明、多塞平、度硫平、氟西汀、舍曲林和安非他酮。
在哺乳婴儿中未检测到可量化的阿米替林、去甲替林、地昔帕明、氯米帕明、度硫平和舍曲林，也未报告有不良反应。因此，这些是哺乳期妇女的首选药物。在一些母亲在哺乳期接受多塞平或氟西汀治疗的幼儿中描述了不良反应。血清水平的总体数据表明，10周以上的婴儿出现三环类药物不良反应的风险较低，且没有蓄积的证据。研究需求包括扩大母婴血清水平数据库、对哺乳期间婴儿的行为评估以及对哺乳婴儿的纵向发育评估。为哺乳期妇女开具抗抑郁药是一个针对具体情况的风险效益决策。
