Last update July 15, 2022

Maternal Depression

Low Risk

Moderately safe. Probably compatible. Mild risk possible. Follow up recommended. Read the Comment.

Postpartum depression is a frequent condition, 5% to 25% within the first postpartum year (Sriraman 2015, ABM 2008, Seyfried 2003). If the mother is not treated, harm effects on both the mother and the infant (psychomotor and growth delay) may occur (Sriraman 2015, Earls 2010, Hirst 2010, Fitelson 2010, ABM 2008, MacQueen 2004). Other authors have found no association between maternal depression in the first 6 months postpartum and infant development at 18 months of age. (Piteo 2012)

Breastfeeding decreases the risk of hospitalization for an affective or psychiatric disorder in the first postpartum year (Xu 2014). Breastfeeding lowers the risk of maternal postpartum depression and anxiety(Alimi 2022, Xia 2022, Toledo 2022, Figueiredo 2021 & 2013, Mikšić 2020, Hahn 2013, Ystrom 2012, Tashakori 2012). Overall, breastfeeding is associated with improved maternal mental health outcomes. However, when there is a discordance between breastfeeding expectations and actual experience, this may not be the case. (Yuen 2022)

Skin-to-skin contact during cesarean section promotes breastfeeding and decreases the risk of postpartum depression. (Zheng 2022)

Mothers who are treated with antidepressant medicaction during pregnancy and/or postpartum are in need of stronger support due to a higher risk of early breastfeeding failure. Maternal depression and/or maternal anxiety are associated with shorter duration of breastfeeding and/or less frequency of exclusive breastfeeding (Kim 2022, Coo 2020, Sha 2019, Vieira 2018, Leggett 2017, Venkatesh 2017, Silva 2017, Figueiredo 2014, Dias 2014, Assarian 2014, Adedinsewo 2014, Jain 2014, Stuebe 2014, Paul 2013, Northrup 2013, Gorman 2012, Gagliardi 2012, Bell 2012, Dennis 2012, Nishioka 2011, Watkins 2011, Fairlie 2009, Dennis 2009, Sharma 2008, Hasselmann 2008, Dennis Apr2007, Hatton 2005, Taj 2003, Henderson 2003, Misri 1997)

Anxiety and depression are associated with lower maternal oxytocin levels during feeding (Stuebe 2013) and lower prolactin levels. (Abou 1998)

Depression is associated with lower level of breastfeeding self-efficacy. (Zubaran 2013)

Neonatal maladaptation that can occur after taking selective serotonin reuptake inhibitors, venlafaxine, or mirtazapine can be lessened if newborns are breastfed. (Kieviet 2013)

Iron deficiency anemia increases the risk of postpartum depression. (Sheikh 2015)

Sudden or forced weaning may affect self-esteem of the mother.

Psychotherapy is effective (Dennis Oct2007, O'Hara 2000) and should be the first choice of treatment (Stuart 2003). In moderate or severe cases whenever a psychotherapeutic treatment fails, other measures like the use of antidepressant drugs should be considered.

Mothers with undiagnosed or untreated depression with selective serotonin reuptake inhibitors are more likely to have low milk production than those treated. (Grzeskowiak 2018)

Most drugs used for treatment of depression are safe since they are hardly excreted into breast milk and they are not a cause of infant problems. (Uguz 2021, Anderson 2021, Becker 2016, Rowe 2013, Hübner 2012, Berle 2011, Davanzo 2011, Lanza 2009, Brockington 2004, MacQueen 2004, Birnbaum 1999)

Selective serotonin reuptake inhibitors are most effective drugs to treat depression. Sertraline and Paroxetine are considered to be the safest. Also, Nortriptyline, Imipramine, Citalopram, Escitalopram, Duloxetine, Fluoxetine, and Fluvoxamine are considered safe. (Anderson 2021, Rowe 2013, Davanzo 2011, Lanza 2009, Berle 2004, Weissman 2004, Gjerdingen 2003, Austin 1998, Wisner 1996)

Antidepressant drugs like Velanfaxin, Moclobemide, Amitriptyline, Amoxapine, Clomipramine and Imipramine are safe while nursing. (Wisner 1996)

The use of short-acting benzodiazepines as anxiolytics is compatible with breastfeeding (Birnbaum 1999, Austin 1998). Those with a short half-life and with known safe data in relation to breastfeeding are preferable:  Clotiazepam , Lorazepam and Oxazepam.


See below the information of these related groups:

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Group

Maternal Depression belongs to this group or family:

References

  1. Toledo C, Cianelli R, Villegas Rodriguez N, De Oliveira G, Gattamorta K, Wojnar D, Ojukwu E. The significance of breastfeeding practices on postpartum depression risk. Public Health Nurs. 2022 Jan;39(1):15-23. Consulted on July 5, 2022 Abstract Full text (link to original source)
  2. Alimi R, Azmoude E, Moradi M, Zamani M. The Association of Breastfeeding with a Reduced Risk of Postpartum Depression: A Systematic Review and Meta-Analysis. Breastfeed Med. 2022 Apr;17(4):290-296. Consulted on July 5, 2022 Abstract
  3. Xia M, Luo J, Wang J, Liang Y. Association between breastfeeding and postpartum depression: A meta-analysis. J Affect Disord. 2022 Jul 1;308:512-519. Consulted on July 5, 2022 Abstract
  4. Zheng Y, Xia Y, Ye W, Zheng C. The Effect of Skin-to-Skin Contact on Postoperative Depression and Physical Recovery of Parturients after Cesarean Section in Obstetrics and Gynecology Department. Comput Math Methods Med. 2022 Jan 22;2022:9927805. Consulted on July 5, 2022 Abstract Full text (link to original source)
  5. Yuen M, Hall OJ, Masters GA, Nephew BC, Carr C, Leung K, Griffen A, McIntyre L, Byatt N, Moore Simas TA. The Effects of Breastfeeding on Maternal Mental Health: A Systematic Review. J Womens Health (Larchmt). 2022 Jun;31(6):787-807. Consulted on July 5, 2022 Abstract
  6. Kim S, Park M, Ahn S. The Impact of Antepartum Depression and Postpartum Depression on Exclusive Breastfeeding: A Systematic Review and Meta-Analysis. Clin Nurs Res. 2022 Jun;31(5):866-880. Consulted on July 5, 2022 Abstract
  7. Figueiredo B, Pinto TM, Costa R. Exclusive Breastfeeding Moderates the Association Between Prenatal and Postpartum Depression. J Hum Lact. 2021 Nov;37(4):784-794. Abstract
  8. Anderson PO. Antidepressants and Breastfeeding. Breastfeed Med. 2021 Jan;16(1):5-7. Abstract
  9. Uguz F. A New Safety Scoring System for the Use of Psychotropic Drugs During Lactation. Am J Ther. 2021 Jan-Feb 01;28(1):e118-e126. Abstract
  10. Mikšić Š, Uglešić B, Jakab J, Holik D, Milostić Srb A, Degmečić D. Positive Effect of Breastfeeding on Child Development, Anxiety, and Postpartum Depression. Int J Environ Res Public Health. 2020 Apr 15;17(8). pii: E2725. Abstract Full text (link to original source)
  11. Coo S, García MI, Mira A, Valdés V. The Role of Perinatal Anxiety and Depression in Breastfeeding Practices. Breastfeed Med. 2020 Aug;15(8):495-500. Abstract
  12. Sha T, Gao X, Chen C, Li L, Cheng G, Wu X, Tian Q, Yang F, He Q, Yan Y. A prospective study of maternal postnatal depressive symptoms with infant-feeding practices in a Chinese birth cohort. BMC Pregnancy Childbirth. 2019 Oct 28;19(1):388. Abstract Full text (link to original source)
  13. Vieira ES, Caldeira NT, Eugênio DS, Lucca MMD, Silva IA. Breastfeeding self-efficacy and postpartum depression: a cohort study. Rev Lat Am Enfermagem. 2018 Sep 6;26:e3035. Abstract Full text (link to original source)
  14. Grzeskowiak LE, Leggett C, Costi L, Roberts CT, Amir LH. Impact of serotonin reuptake inhibitor use on breast milk supply in mothers of preterm infants: a retrospective cohort study. Br J Clin Pharmacol. 2018 Jun;84(6):1373-1379. Abstract Full text (link to original source)
  15. Leggett C, Costi L, Morrison JL, Clifton VL, Grzeskowiak LE. Antidepressant Use in Late Gestation and Breastfeeding Rates at Discharge from Hospital. J Hum Lact. 2017 Nov;33(4):701-709. Abstract
  16. Silva CS, Lima MC, Sequeira-de-Andrade LAS, Oliveira JS, Monteiro JS, Lima NMS, Santos RMAB, Lira PIC. Association between postpartum depression and the practice of exclusive breastfeeding in the first three months of life. J Pediatr (Rio J). 2017 Jul - Aug;93(4):356-364. Abstract Full text (link to original source)
  17. Venkatesh KK, Castro VM, Perlis RH, Kaimal AJ. Impact of antidepressant treatment during pregnancy on obstetric outcomes among women previously treated for depression: an observational cohort study. J Perinatol. 2017 Sep;37(9):1003-1009. Abstract
  18. Becker M, Weinberger T, Chandy A, Schmukler S. Depression During Pregnancy and Postpartum. Curr Psychiatry Rep. 2016 Mar;18(3):32. Abstract
  19. Sriraman NK, Melvin K, Meltzer-Brody S. ABM Clinical Protocol #18: Use of Antidepressants in Breastfeeding Mothers. Breastfeed Med. 2015 Abstract Full text (link to original source) Full text (in our servers)
  20. Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. J Affect Disord. 2015 Jan 15;171:142-54. Abstract Full text (link to original source)
  21. Sheikh M, Hantoushzadeh S, Shariat M, Farahani Z, Ebrahiminasab O. The efficacy of early iron supplementation on postpartum depression, a randomized double-blind placebo-controlled trial. Eur J Nutr. 2015 Abstract
  22. Figueiredo B, Canário C, Field T. Breastfeeding is negatively affected by prenatal depression and reduces postpartum depression. Psychol Med. 2014 Apr;44(5):927-36. Abstract
  23. Xu F, Li Z, Binns C, Bonello M, Austin MP, Sullivan E. Does infant feeding method impact on maternal mental health? Breastfeed Med. 2014 Abstract
  24. Adedinsewo DA, Fleming AS, Steiner M, Meaney MJ, Girard AW; MAVAN team. Maternal anxiety and breastfeeding: findings from the MAVAN (Maternal Adversity, Vulnerability and Neurodevelopment) Study. J Hum Lact. 2014 Abstract
  25. Stuebe AM, Horton BJ, Chetwynd E, Watkins S, Grewen K, Meltzer-Brody S. Prevalence and risk factors for early, undesired weaning attributed to lactation dysfunction. J Womens Health (Larchmt). 2014 Abstract Full text (link to original source)
  26. Assarian F, Moravveji A, Ghaffarian H, Eslamian R, Atoof F. The association of postpartum maternal mental health with breastfeeding status of mothers: a case-control study. Iran Red Crescent Med J. 2014 Abstract Full text (link to original source) Full text (in our servers)
  27. Stuebe AM, Grewen K, Meltzer-Brody S. Association between maternal mood and oxytocin response to breastfeeding. J Womens Health (Larchmt). 2013 Abstract Full text (link to original source) Full text (in our servers)
  28. Figueiredo B, Dias CC, Brandão S, Canário C, Nunes-Costa R. Breastfeeding and postpartum depression: state of the art review. J Pediatr (Rio J). 2013 Jul-Aug;89(4):332-8. Abstract Full text (link to original source)
  29. Northrup TF, Wootton SH, Evans PW, Stotts AL. Breastfeeding practices in mothers of high-respiratory-risk NICU infants: impact of depressive symptoms and smoking. J Matern Fetal Neonatal Med. 2013 Abstract
  30. Hahn-Holbrook J, Haselton MG, Dunkel Schetter C, Glynn LM. Does breastfeeding offer protection against maternal depressive symptomatology?: A prospective study from pregnancy to 2 years after birth. Arch Womens Ment Health. 2013 Abstract Full text (link to original source)
  31. Rowe H, Baker T, Hale TW. Maternal medication, drug use, and breastfeeding. Pediatr Clin North Am. 2013 Feb;60(1):275-94. Abstract
  32. Paul IM, Downs DS, Schaefer EW, Beiler JS, Weisman CS. Postpartum anxiety and maternal-infant health outcomes. Pediatrics. 2013 Abstract Full text (link to original source) Full text (in our servers)
  33. Zubaran C, Foresti K. The correlation between breastfeeding self-efficacy and maternal postpartum depression in southern Brazil. Sex Reprod Healthc. 2013 Abstract
  34. Kieviet N, Dolman KM, Honig A. The use of psychotropic medication during pregnancy: how about the newborn? Neuropsychiatr Dis Treat. 2013 Abstract Full text (link to original source) Full text (in our servers)
  35. Tashakori A, Behbahani AZ, Irani RD. Comparison Of Prevalence Of Postpartum Depression Symptoms Between Breastfeeding Mothers And Non-breastfeeding Mothers. Iran J Psychiatry. 2012 Abstract Full text (link to original source) Full text (in our servers)
  36. Gorman JR, Kao K, Chambers CD. Breastfeeding among women exposed to antidepressants during pregnancy. J Hum Lact. 2012 Abstract
  37. Ystrom E. Breastfeeding cessation and symptoms of anxiety and depression: a longitudinal cohort study. BMC Pregnancy Childbirth. 2012 Abstract Full text (link to original source) Full text (in our servers)
  38. Piteo AM, Yelland LN, Makrides M. Does maternal depression predict developmental outcome in 18 month old infants? Early Hum Dev. 2012 Abstract
  39. Dennis CL, Gagnon A, Van Hulst A, Dougherty G. Predictors of breastfeeding exclusivity among migrant and Canadian-born women: results from a multi-centre study. Matern Child Nutr. 2012 Abstract Full text (link to original source)
  40. Hübner-Liebermann B, Hausner H, Wittmann M. Recognizing and treating peripartum depression. Dtsch Arztebl Int. 2012 Jun;109(24):419-24. Abstract Full text (link to original source) Full text (in our servers)
  41. Gagliardi L, Petrozzi A, Rusconi F. Symptoms of maternal depression immediately after delivery predict unsuccessful breast feeding. Arch Dis Child. 2012 Abstract
  42. Bell L, Lacombe M, Gallagher F, Ferland M, Couture ME. [The factors involved in the decision to stop breastfeeding early]. Soins Pediatr Pueric. 2012 Abstract
  43. Nishioka E, Haruna M, Ota E, Matsuzaki M, Murayama R, Yoshimura K, Murashima S. A prospective study of the relationship between breastfeeding and postpartum depressive symptoms appearing at 1-5 months after delivery. J Affect Disord. 2011 Abstract
  44. Berle JO, Spigset O. Antidepressant Use During Breastfeeding. Curr Womens Health Rev. 2011 Abstract Full text (link to original source) Full text (in our servers)
  45. Davanzo R, Copertino M, De Cunto A, Minen F, Amaddeo A. Antidepressant drugs and breastfeeding: a review of the literature. Breastfeed Med. 2011 Abstract
  46. Watkins S, Meltzer-Brody S, Zolnoun D, Stuebe A. Early breastfeeding experiences and postpartum depression. Obstet Gynecol. 2011 Abstract
  47. Earls MF; Committee on Psychosocial Aspects of Child and Family Health American Academy of Pediatrics. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010 Abstract
  48. Hirst KP, Moutier CY. Postpartum major depression. Am Fam Physician. 2010 Abstract
  49. Fitelson E, Kim S, Baker AS, Leight K. Treatment of postpartum depression: clinical, psychological and pharmacological options. Int J Womens Health. 2010 Abstract
  50. Lanza di Scalea T, Wisner KL. Antidepressant medication use during breastfeeding. Clin Obstet Gynecol. 2009 Abstract Full text (link to original source) Full text (in our servers)
  51. Fairlie TG, Gillman MW, Rich-Edwards J. High pregnancy-related anxiety and prenatal depressive symptoms as predictors of intention to breastfeed and breastfeeding initiation. J Womens Health (Larchmt). 2009 Abstract
  52. Dennis CL, McQueen K. The relationship between infant-feeding outcomes and postpartum depression: a qualitative systematic review. Pediatrics. 2009 Abstract
  53. Academy of Breastfeeding Medicine Protocol Committee. ABM clinical protocol #18: use of antidepressants in nursing mothers. Breastfeed Med. 2008 Abstract Full text (link to original source) Full text (in our servers)
  54. Sharma V, Corpse CS. Case study revisiting the association between breastfeeding and postpartum depression. J Hum Lact. 2008 Abstract
  55. Hasselmann MH, Werneck GL, Silva CV. Symptoms of postpartum depression and early interruption of exclusive breastfeeding in the first two months of life. Cad Saude Publica. 2008 Abstract
  56. Dennis CL, McQueen K. Does maternal postpartum depressive symptomatology influence infant feeding outcomes? Acta Paediatr. 2007 Apr;96(4):590-4 Abstract
  57. Dennis CL, Hodnett E. Psychosocial and psychological interventions for treating postpartum depression. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006116. Abstract
  58. Hatton DC, Harrison-Hohner J, Coste S, Dorato V, Curet LB, McCarron DA. Symptoms of postpartum depression and breastfeeding. J Hum Lact. 2005 Abstract
  59. Brockington I. Postpartum psychiatric disorders. Lancet. 2004 Abstract
  60. MacQueen G, Chokka P. Special issues in the management of depression in women. Can J Psychiatry. 2004 Mar;49(3 Suppl 1):27S-40S. Review. Abstract
  61. Weissman AM, Levy BT, Hartz AJ, Bentler S, Donohue M, Ellingrod VL, Wisner KL. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004 Abstract Full text (link to original source) Full text (in our servers)
  62. Berle JØ, Steen VM, Aamo TO, Breilid H, Zahlsen K, Spigset O. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome p450 genotypes. J Clin Psychiatry. 2004 Abstract
  63. Stuart S, O'Hara MW, Gorman LL. The prevention and psychotherapeutic treatment of postpartum depression. Arch Womens Ment Health. 2003 Abstract
  64. Gjerdingen D. The effectiveness of various postpartum depression treatments and the impact of antidepressant drugs on nursing infants. J Am Board Fam Pract. 2003 Abstract Full text (link to original source) Full text (in our servers)
  65. Taj R, Sikander KS. Effects of maternal depression on breast-feeding. J Pak Med Assoc. 2003 Abstract
  66. Henderson JJ, Evans SF, Straton JA, Priest SR, Hagan R. Impact of postnatal depression on breastfeeding duration. Birth. 2003 Abstract
  67. Seyfried LS, Marcus SM. Postpartum mood disorders. Int Rev Psychiatry. 2003 Abstract
  68. O'Hara MW, Stuart S, Gorman LL, Wenzel A. Efficacy of interpersonal psychotherapy for postpartum depression. Arch Gen Psychiatry. 2000 Abstract
  69. Birnbaum CS, Cohen LS, Bailey JW, Grush LR, Robertson LM, Stowe ZN. Serum concentrations of antidepressants and benzodiazepines in nursing infants: A case series. Pediatrics. 1999 Abstract Full text (link to original source)
  70. Abou-Saleh MT, Ghubash R, Karim L, Krymski M, Bhai I. Hormonal aspects of postpartum depression. Psychoneuroendocrinology. 1998 Abstract
  71. Austin MP, Mitchell PB. Use of psychotropic medications in breast-feeding women: acute and prophylactic treatment. Aust N Z J Psychiatry. 1998 Abstract
  72. Misri S, Sinclair DA, Kuan AJ. Breast-feeding and postpartum depression: is there a relationship? Can J Psychiatry. 1997 Abstract
  73. Wisner KL, Perel JM, Findling RL. Antidepressant treatment during breast-feeding. Am J Psychiatry. 1996 Sep;153(9):1132-7. Review. Abstract

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