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TCAs

In the treatment of depression during pregnancy, tricyclics are the agents of


choice because there is more experience in their use
Tachycardia, irritability, and muscle spasms in the neonate have been reported
with imipramine
SSRIs
There is less experience using SSRIs in pregnancy because they are newer
antidepressants
There is most information for fluoxetine although the evidence is conflicting.
Some studies show that fluoxetine is associated with minor birth defects although
other studies have not supported this finding. The BN reports no evidence of
teratogenicity with fluoxetine.
!aroxetine and fluvoxamine are not thought to be associated with significant
ris"s, but are newer medicines.
#void sertraline $adverse effects in animals%
MAOIs
#void in pregnancy
Newer antidepressants e.g. &irta'apine, Reboxetine,(enlafaxine, Nefa'odone
)ittle information available
Benzodiazepines
These medicines should be avoided particularly in the first three months
because there may be a small ris" of abnormalities
*igh doses during late pregnancy or labour may cause neonatal hypothermia,
hypotonia and respiratory depression
Breastfed babies may feel sleepy
The use of antidepressants during breastfeeding
Breastfeeding during maternal pharmacotherapy is acceptable if the ris" +
benefit analysis is carefully considered and the mother + baby pair is monitored
*owever the chance that chronic exposure to very low doses of antidepressants
may affect newborn behavioural function in some undiscovered manner remains a
concern
,iven the undetectable serum levels of parent drugs in infants with the
recommended medications this possibility seems unli"ely
If medication was ta"en during pregnancy, continue with the same medication
postpartum
Treat the mother with the lowest effective dose $ adverse effects are often dose
related%
&onitor the infant for adverse effects e.g. sedation and irritability
TCAs
#void doxepin and tra'odone
!referred options- amitriptyline and nortriptyline
)ess data exists than for T.#s
Studies have found that serum concentrations of medication were undetectable
in all infants exposed to paroxetine or fluvoxamine and in the ma/ority of infants
exposed to sertraline while breast feeding
The preferred options are paroxetine, fluvoxamine and sertraline
#dverse effects have been reported with fluoxetine e.g. neonatal irritablility,
sleep disturbance and poor feeding
.italopram may cause a dose dependent uneasy sleep

TCAs SSRIs &#0Is


Recommended
1rugs 1uring
Breastfeeding
#void
doxepin
and
tra'odon
e
!referred
options-
amitriptyline
and
nortriptyline
)ess data
exists than
for T.#s
Studies
have
found that
serum
concentrati
ons of
medication
were
undetectab
le in all
infants
exposed to
#void
during
breast
feeding
paroxetine
or
fluvoxami
ne and in
the
ma/ority
of infants
exposed to
sertraline
while
breast
feeding
The
preferred
options are
paroxetine
,
fluvoxami
ne and
sertraline
#dverse
effects
have been
reported
with
fluoxetine
e.g.
neonatal
irritablility
, sleep
disturbanc
e and poor
feeding

.italopram
may cause a
dose
dependent
uneasy sleep