Consensus Panel Recommendations for the Pharmacological Management of Breastfeeding Women with Postpartum Depression

Georgios Eleftheriou (), Riccardo Zandonella Callegher, Raffaella Butera, Marco De Santis, Anna Franca Cavaliere, Sarah Vecchio, Cecilia Lanzi, Riccardo Davanzo, Giovanna Mangili, Emi Bondi, Lorenzo Somaini, Mariapina Gallo, Matteo Balestrieri, Guido Mannaioni, Guglielmo Salvatori and Umberto Albert
Additional contact information
Georgios Eleftheriou: Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy
Riccardo Zandonella Callegher: Italian Society of Psychiatry (SIP), Piazza Santa Maria della Pietà 5, 00135 Rome, Italy
Raffaella Butera: Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy
Marco De Santis: Italian Society of Obstetrics and Gynecology (SIGO), Via di Porta Pinciana 6, 00187 Rome, Italy
Anna Franca Cavaliere: Italian Society of Obstetrics and Gynecology (SIGO), Via di Porta Pinciana 6, 00187 Rome, Italy
Sarah Vecchio: Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy
Cecilia Lanzi: Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy
Riccardo Davanzo: Italian Society of Neonatology (SIN), Corso Venezia 8, 20121 Milan, Italy
Giovanna Mangili: Italian Society of Neonatology (SIN), Corso Venezia 8, 20121 Milan, Italy
Emi Bondi: Italian Society of Psychiatry (SIP), Piazza Santa Maria della Pietà 5, 00135 Rome, Italy
Lorenzo Somaini: Ser.D Biella, Drug Addiction Service, 13875 Biella, Italy
Mariapina Gallo: Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy
Matteo Balestrieri: Psychiatry Unit, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
Guido Mannaioni: Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy
Guglielmo Salvatori: Italian Society of Pediatrics, Via Gioberti 60, 00185 Rome, Italy
Umberto Albert: Italian Society of Psychiatry (SIP), Piazza Santa Maria della Pietà 5, 00135 Rome, Italy

IJERPH, 2024, vol. 21, issue 5, 1-27

Abstract: Introduction: Our consensus statement aims to clarify the use of antidepressants and anxiolytics during breastfeeding amidst clinical uncertainty. Despite recent studies, potential harm to breastfed newborns from these medications remains a concern, leading to abrupt discontinuation of necessary treatments or exclusive formula feeding, depriving newborns of benefits from mother’s milk. Methods: A panel of 16 experts, representing eight scientific societies with a keen interest in postpartum depression, was convened. Utilizing the Nominal Group Technique and following a comprehensive literature review, a consensus statement on the pharmacological treatment of breastfeeding women with depressive disorders was achieved. Results: Four key research areas were delineated: (1) The imperative to address depressive and anxiety disorders during lactation, pinpointing the risks linked to untreated maternal depression during this period. (2) The evaluation of the cumulative risk of unfavorable infant outcomes associated with exposure to antidepressants or anxiolytics. (3) The long-term impact on infants’ cognitive development or behavior due to exposure to these medications during breastfeeding. (4) The assessment of pharmacological interventions for opioid abuse in lactating women diagnosed with depressive disorders. Conclusions: The ensuing recommendations were as follows: Recommendation 1: Depressive and anxiety disorders, as well as their pharmacological treatment, are not contraindications for breastfeeding. Recommendation 2: The Panel advocates for the continuation of medication that has demonstrated efficacy during pregnancy. If initiating an antidepressant during breastfeeding is necessary, drugs with a superior safety profile and substantial epidemiological data, such as SSRIs, should be favored and prescribed at the lowest effective dose. Recommendation 3: For the short-term alleviation of anxiety symptoms and sleep disturbances, the Panel determined that benzodiazepines can be administered during breastfeeding. Recommendation 4: The Panel advises against discontinuing opioid abuse treatment during breastfeeding. Recommendation 5: The Panel endorses collaboration among specialists (e.g., psychiatrists, pediatricians, toxicologists), promoting multidisciplinary care whenever feasible. Coordination with the general practitioner is also recommended.

Keywords: breastfeeding; postpartum depression; antidepressants; anxiolytic drugs; consensus (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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