Maternal Sertraline Treatment and Serotonin Transport in Breast-Feeding Mother-Infant Pairs

Epperson, Neill; Czarkowski, Kathryn A.; Ward-O’Brien, Deborah; Weiss, Erica L.; Gueorguieva, Ralitza; Jatlow, Peter; Anderson, George M.

doi:10.1176/appi.ajp.158.10.1631

Cited by 114 publications

(62 citation statements)

References 55 publications

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“…The usual absence of a discernible effect on infant platelet serotonin transport is consistent with the relatively low levels of sertraline in infant plasma [38].…”

Section: Sertralinesupporting

confidence: 61%

Use of Antidepressants to Treat Postpartum Depression, During Breast Feeding

Fonseca¹,

Leal²

2014

J Depress Anxiety

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Postpartum depression affects approximately 14.5% of women and it can affect both mother and infant. Therefore, rapid attention and treatment are imperative. The pharmacological approach often represents one of the most realistic options of treatment. However, women may be reluctant to take antidepressants because of the fear of adverse effects for the infant, since that most drugs pass into breast milk. The use of pharmacotherapy has not been extensively documented in this population. The objective of this review is to evaluate the risk benefit of using antidepressants during breastfeeding to treat postpartum depression.An electronic search was performed by using PubMed database, from January 2001 through December 2010. The search was limited to articles in the English language and to articles that relate human's research. Manual searches of bibliographies were also conducted to identify additional pertinent studies.The use of antidepressants that do not appear in infants' plasma, for which use during breastfeeding is better documented and at standard therapeutic doses is recommended, such as sertraline and paroxetine. Fluoxetine has a long half-life which can lead to a long infant exposition through breast milk and citalopram can cause adverse effects in infants exposed through breast milk. Therefore, citalopram and fluoxetine should not be used as first-line treatments. More information is needed about the use of the other antidepressants referred in this study.This study aims to emphasize the importance of postpartum depression treatment, always considering its repercussions for the breastfed infants. Studies are needed with larger samples to properly evaluate the short and long-term effects of antidepressants on infants exposed through breast milk, so that clinicians can create standard decisions regarding the treatment of postpartum depression, without putting infants at risk.

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“…The usual absence of a discernible effect on infant platelet serotonin transport is consistent with the relatively low levels of sertraline in infant plasma [38].…”

Section: Sertralinesupporting

confidence: 61%

Use of Antidepressants to Treat Postpartum Depression, During Breast Feeding

Fonseca¹,

Leal²

2014

J Depress Anxiety

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“…The impact of central serotonin 5-HT modulation by SSRI during critical periods of brain development is unknown. Although preclinical studies indicate that 5-HT plays important roles in neurogenesis and neural growth (14 -20), it is unclear how transporter inhibition affects early neurodevelopment in humans.Research on fetal and neonatal exposure to SSRI has been recently reviewed (10,11,21,22). Although substantial and physiologically meaningful infant SSRI exposure through breast-feeding by mothers receiving SSRI is probably infre- 0031-3998/04/5603-0418 PEDIATRIC RESEARCH Vol.…”

mentioning

confidence: 99%

“…Research on fetal and neonatal exposure to SSRI has been recently reviewed (10,11,21,22). Although substantial and physiologically meaningful infant SSRI exposure through breast-feeding by mothers receiving SSRI is probably infre- 0031-3998/04/5603-0418 PEDIATRIC RESEARCH Vol.…”

mentioning

confidence: 99%

“…Research on fetal and neonatal exposure to SSRI has been recently reviewed (10,11,21,22). Although substantial and physiologically meaningful infant SSRI exposure through breast-feeding by mothers receiving SSRI is probably infre-quent (9 -11, 23), gestational exposure has been reported to have marked biochemical effects and may have significant clinical effects (21,22).…”

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confidence: 99%

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Platelet Serotonin in Newborns and Infants: Ontogeny, Heritability, and Effect of In Utero Exposure to Selective Serotonin Reuptake Inhibitors

et al. 2004

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Ontogeny of platelet serotonin (5-hydroxytryptamine, 5-HT) during the first year of life was examined in newborns and infants. The effects of in utero exposure to selective serotonin reuptake inhibitors (SSRI, including fluoxetine, sertraline, and citalopram) were examined by comparing cord blood 5-HT levels in exposed and unexposed newborns. Heritability was assessed by correlation of the platelet 5-HT values observed for mother-infant pairs. No age effect was observed in 1-49 wk-old infants (r ϭ 0.13, p ϭ 0.49) and mean platelet 5-HT levels in infants (241 Ϯ 102 ng/mL, n ϭ 33; 615 Ϯ 320 ng/10 9 platelets, n ϭ 32) were similar to those reported for older children and adults. However, significantly lower blood 5-HT levels were observed in newborns (81.3 Ϯ 32.5 ng/mL, n ϭ 16, p Ͻ 0.0001; 297 Ϯ 101 ng/10 9 platelets, n ϭ 11, p ϭ 0.0007) compared with the 1-49 wk-old infants. The mean cord blood 5-HT concentrations in newborns exposed in utero to SSRI (n ϭ 8) were substantially lower than that seen in unexposed (n ϭ 16) newborns (20.6 Ϯ 14.4 versus. 81.3 Ϯ 32.5 ng/mL, p ϭ 0.0001; 90.7 Ϯ 55.4 versus. 297 Ϯ 101 ng/10 9 platelets, p ϭ 0.0005). Platelet serotonin levels (ng/10 9 platelets) in mother-child pairs (n ϭ 32) were significantly correlated (r ϭ 0.415, p ϭ 0.018). The results indicate that, although platelet 5-HT is low at birth, values quickly increase and stabilize at near-adult levels by 1 mo of age. Gestational exposure to SSRI appears to substantially reduce platelet 5-HT uptake in the fetus, strongly suggesting that such exposure has important physiologic effects. The observed mother-infant correlation agrees with a previous report of high heritability in a large adult population. There is a continuing interest in platelet serotonin (5-HT) due to its hemostatic, thrombogenic, and cardiovascular effects (1, 2), its utility in assessing the bioeffects of SSRI (3-5), and its alteration in several neuropsychiatric disorders (6 -8). In prior work (9 -11), we carried out a series of studies examining the effects of SSRI exposure on platelet 5-HT in nursing infants and in the present study seek to extend the available data regarding the normal ontogeny of platelet 5-HT in infants. We also wished to establish more firmly prior reports of low platelet 5-HT levels in newborn cord blood and to examine the effects of gestational SSRI exposure on cord blood levels.Finally, our investigations of nursing mother-infant pairs provided the opportunity to contribute to the limited data assessing the heritability of platelet 5-HT.The platelet and neuronal 5-HT transporters are encoded by the same gene and appear identical in terms of pharmacology (12, 13). All platelet 5-HT is accumulated by uptake through the platelet membrane 5-HT transporter and a number of studies have used the decline in platelet 5-HT seen after administration of reuptake inhibitors as an index of central and peripheral transporter blockade (3-5). The impact of central serotonin 5-HT modulation by SSRI during critical periods of brain development is un...

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“…Others found undetectable levels in serum or levels of sertraline and its active metabolite desmethylsertraline of less than 10 ng/ml . Epperson et al (2001) studied serotonin (5-HT) transport in nine pairs of mothers and infants and concluded that at clinical doses of sertraline, platelet 5-HT uptake in nursing infants was unaltered and mothers taking sertraline could breast-feed without appreciably affecting peripheral or central 5-HT transport in their infants.…”

Section: Sertralinementioning

confidence: 99%

Psychotropic medication and breast-feeding

Kohen¹

2005

Adv. psychiatr. treat

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The physical and psychological benefits of breastfeeding for the mother and the infant are numerous and range from improved and stronger bonding to better immunological protection. Breast-fed infants have fewer episodes of middle-ear and urinary tract infections and lower mortality rates than bottle-fed babies (Nulman et al, 2003). Breast milk contains nucleotides and enzymes that promote digestion and absorption of nutrients. Breast-feeding has been associated with better cognitive functioning and better performance on IQ measures at age 7-8 years (Fergusson et al, 1982;Lucas et al, 1992).For the mother, breast-feeding causes oxytocin and prolactin release, precipitates postnatal uterine involution and suppresses ovulatory cycles.Breast-feeding has been successfully promoted in recent decades and a significantly large group of women now believe in its benefits and enquire about the possibilities of breast-feeding even when they are on psychotropic medication. It is the duty of the prescribing psychiatrist to guide the mother, the carers, the community mental health team, the general practitioner (GP), the obstetricians and the paediatricians through the intricacies of this complex area of psychopharmacology, in which there is an increasing interest but only scant research, few case studies and limited publications. Pharmacokinetics of psychotropics in breast milkResearchers need information on four factors in order to understand problems related to breastfeeding by mothers taking psychotropic medication: the prescribed dose; the level of the drug in the mother's blood plasma; the level in the breast milk; and the levels in the infant's serum. The amount of drug excreted in the milk is important in evaluating any drug-induced toxicity in the infant.The medication's diffusion across membranes, its molecular weight and its lipophilicity each play an important role in determining the amount that enters the breast milk (Nulman et al, 2003).The milk that comes out towards the end of a feed (hind milk) has a higher concentration of lipids than the thinner foremilk. Consequently, hind milk will contain a greater concentration of any lipid-soluble drug. Colostrum, produced only during the first few days after birth, has a higher protein level and will therefore contain a greater concentration of proteinbound drugs.To evaluate infant exposure to a drug the concentration of the medication or its metabolite are measured simultaneously in the mother's plasma and breast milk. A milk/plasma ratio greater than 1 Psychotropic medication and breast-feeding Dora KohenAbstract Adverse effects of psychotropic medication on breast-fed infants have not been studied in controlled and systematic research. Existing information comes from small case series and single case reports. These limited data confirm that psychotropics are excreted into breast milk and that the infant is exposed to them. In recent decades sufficient data have accumulated to allow psychiatrists to prescribe tricyclic antidepressants, selective serotonin reuptake in...

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Maternal Sertraline Treatment and Serotonin Transport in Breast-Feeding Mother-Infant Pairs

Cited by 114 publications

References 55 publications

Use of Antidepressants to Treat Postpartum Depression, During Breast Feeding

Use of Antidepressants to Treat Postpartum Depression, During Breast Feeding

Platelet Serotonin in Newborns and Infants: Ontogeny, Heritability, and Effect of In Utero Exposure to Selective Serotonin Reuptake Inhibitors

Psychotropic medication and breast-feeding

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