A new study has found an association between the use of some common antidepressant medications and delayed of milk "coming in." An article on the study reports:
"The breasts are serotonin-regulated glands, meaning the breasts' ability to secrete milk at the right time is closely related to the body's production and regulation of the hormone serotonin," said Nelson Horseman, PhD, of the University of Cincinnati and co-author of the study. "Common antidepressant drugs like fluoxetine, sertraline and paroxetine are known as selective serotonin reuptake inhibitor (SSRI) drugs and while they can affect mood, emotion and sleep they may also impact serotonin regulation in the breast, placing new mothers at greater risk of a delay in the establishment of a full milk supply."
In this study, researchers examined the effects of SSRI drugs on lactation using laboratory studies of human and animal cell lines and genetically modified mice. Furthermore, an observational study evaluated the impact of SSRI drugs on the onset of milk production in postpartum women. In this study of 431 postpartum women, median onset of lactation was 85.8 hours postpartum for the SSRI-treated mothers and 69.1 hours for mothers not treated with SSRI drugs. Researchers commonly define delayed secretory activation as occurring later than 72 hours postpartum.
Note that this study concerns mothers who were taking antidepressants at the time of their babies' births. I don't think any claims are being made about the use of antidepressants after the onset of full milk production.
As I'm sure you know, delayed milk "coming in" can have some serious consequences, especially if it isn't managed well. The drill goes something like this: delayed onset of mature milk leads to higher than normal weight loss in the baby, which leads to supplementation, which can lead to compromising of the milk supply and/or nipple preferencing if the supplementation isn't done carefully. It can also increase the risk of jaundice.
I checked my handy copy of Medications and Mothers' Milk, and there is no mention of this effect in the write ups for fluoxetine (Prozac), sertraline (Paxil), paroxetine (Zoloft).
Obviously, mothers aren't usually on antidepressants in pregnancy unless there is a very good reason for it, so in most cases this probably can't be avoided. But this new evidence makes me wonder if we shouldn't consider telling mothers (as we should - but usually don't - for other things that can cause a delay, like diabetes), that it might take a little longer for their mature milk to come in.
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