Maternal Depression

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:

• ATC N05B: Anxiolytics
• ATC N06A Antidepressants