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Depression drugs, smoking prompt revised guidelines

The nation’s leading group of baby doctors is revising its advice on when women should not breast-feed. The recommendations may provide relief for mothers who smoke, but they’re a toss-up for moms who take antidepressants.

The American Academy of Pediatrics (AAP) is moving from a thumbs-down to a neutral position on whether smokers should nurse instead of using formula. Also, the academy is expanding its discussion of how mental-health drugs could be trouble for babies, but the organization still isn’t taking a firm stand on that issue.

In both cases, there simply isn’t enough evidence to tell doctors exactly what to do, says Dr. Cheston Berlin, professor of pediatrics at Pennsylvania State University and co-author of the updated guidelines, which appear in the September issue of Pediatrics.

“We have to recognize that there are many things in medicine for which there are not straightforward answers. The patient needs to be given the information or lack of information and decide what they want to do,” Berlin says.

The AAP first published guidelines about breast-feeding in 1983 amid concern that drugs taken by mothers could make their way into breast milk, Berlin says. The recommendations were last revised in 1994.

“The reason for the update is because of the continuing development of new information. There’s more information about new drugs, and we’re also getting better instrumentation to measure some of the older drugs [in breast milk] as well,” he says.

The academy remains firmly in favor of breast milk over formula, he says. “The bright side is that virtually all medications given to mothers are compatible with continuing to breast-feed.”

But some drugs, including cancer medications and illegal drugs, could work their way into breast milk from the bloodstream, says Dr. Ami Goodman, a pediatrician and neonatologist with Kaiser Permanente Medical Center in San Francisco.

Anti-psychotic drugs and antidepressants like Prozac and Paxil could also create problems. Berlin says, “If a mother is taking Prozac and nursing, the baby is getting Prozac. We can’t answer whether that is a good or bad idea. The long-term effect on a baby who nurses from a mother who takes these drugs is unclear.”

The drugs affect neurotransmitters, and scientists aren’t sure how they would affect the developing brain of a baby.

Because of reports that prozac causes increased colic and fussiness in infants, Goodman says he recommends that breast-feeding mothers who are depressed take Paxil or Zoloft instead.

Both Goodman and Berlin suggest that mothers could reduce risks by taking drugs immediately after breast-feeding, so they could clear the mother’s system before she nurses again.

In a second major area, the academy will announce that it has no recommendation about whether smokers should breast-feed. “There is some evidence that suggests that babies of mothers who smoke and breast-feed may have less difficulty than if they smoke and bottle-feed,” Berlin says.

Protective chemicals in breast milk may help babies fight off respiratory illness, he says.

However, the academy continues to strongly advise against smoking, reflecting the consensus of the medical community. “What is clear is that maternal smoking is not good for any baby,” Goodman says.

Finally, the academy is recommending that women with breast implants be encouraged to breast-feed. Despite past concerns that silicone in implants could transfer to babies, research has shown there’s no reason for worry, Berlin says.