Breastfeeding: Are antidepressants safe when nursing a toddler?

My daughter is almost four and still nursing. It's mostly a nighttime thing, but at three to five times a night, she is certainly getting more than a few drops. I've been taking Prozac for the past six months with the assurance from more than one doctor that it will not affect her in any adverse way. I am still a bit concerned. Do you feel that a medication such as prozac would be less likely to have a harmful effect on children when they're older and getting most of their nutrients from solid food?

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Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

Your question is excellent. The amount of medication that your child receives through your milk is dependent on several factors. I won't go into the mechanisms at this time, but I will explain how the amount of the medication your child receives through your milk varies, depending on her intake.

Infants receive all their nutrition through your milk. Older nursing children (over one year old) usually obtain much of their nutrition from other dietary sources, so it is highly unlikely your daughter is taking in the quantity of milk an infant would.

With Prozac (fluoxetine) appearing in breastmilk in the range of approximately 24.8 to 181.1 micrograms per liter (close to a quart), you can see why a newborn, who might be consuming one liter of breastmilk per day would be taking in more than a toddler, consuming much less than this amount. Now of course, this is all speculative. I have no way of knowing your daughter's intake of breastmilk. But, I do know she is much larger than an infant. She may have three to four times the body weight of an infant, and that does affect the way her body handles a medication.

Dr. Hale, author of Medications and Mother's Milk, feels that the use of Prozac in mother of infants older than four to six months does not pose a hazard because they can metabolize and excrete the medication more rapidly.

In most of the studies examining Prozac's use in breastfeeding women, the mother's dose was in the range of 20 to 35 mg. per day. Your dose will affect the amount that is transferred into your breastmilk. Since milk levels peak at six hours with Prozac, you might want to take your medication in the morning, since your child only nurses at night.

It is very important to remember that almost all moms and their nursing babies will be exposed to some over-the-counter or prescription drugs during lactation. Most present no problem at all to the nursing baby. In fact, with most medications, a baby receives no more than 0.5 to 1 percent of the maternal dose (though it ranges from 5 to 9 percent with Prozac). I do caution nursing mothers to check with their Health Care Provider and Lactation Consultant if they will be using any medication while nursing. Best wishes!

Reference:

  • Hale, T., Medications and Mother's Milk, 2000, Pharmasoft Publishing Austin Texas, 278-80.
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