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Escitalopram + breastfeeding (2,5 yo)

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  • Escitalopram + breastfeeding (2,5 yo)

    I suffer from anxiety dissorder and depression, i've chosen to live without any medication since my daughter was born 2,5 years ago. I have tried natural remedies but nothing has really worked. I breastfeed my daughter and it is something really important for us.
    I have been seeing a psychiatrist, she suggests that i take Sipralexa (Escitalopram) whenever i feel ready, but she is against combining breastfeeding and antidepressants, she says that it is not proven that the moleculles affect the toddler but it's not well proven that they don't.
    She is affraid that if something happened to my daughter later (mentally), i would maybe feel that it was my fault for taking the medication and breastfeeding her. That's exactly why i haven't tried any medication until now.
    I'm tired of living like this, being a monster sometimes, to myself mostly, and not being able to stop it.
    I have to say that i try and protect my daughter from seeing that something is wrong.
    I need your opinion on this, please.

  • #2
    Hi paoCP, thanks for your question.

    Dr. Hale and I have discussed this one and here's what we think: Several recent studies on escitalopram in breastfeeding and pregnancy indicated that infants 0-6mo old get about 5-7% of the mother's daily dose in the breast milk. In those infants, the drug and it's primary metabolite were undetectable in the infant's blood. No side effects have been reported at that level of exposure. For older children like yours, we know that their kidney and liver function is as good as an adult's and they can clear medications as well as you can. They also have larger bodies so their dose per body weight is much more favorable than an infant's as well. Finally, we know that the amount of mother's medication that is transferred to the baby reduces as she ages - mostly due to the decreasing volume of milk that she drinks.

    Your doctor is right that this drug has not been proven to be safe for toddlers, but the fact is that science has never been good at proving things beyond a shadow of a doubt. Right now, the evidence is strong suggesting that breastfeeding on this medication will be safe for your child. We give escitalopram an L2 (out of 5) ("probably safe") with regards to its lactation safety. Consider that being depressed or anxious around your child may also be harmful. Your wellbeing is important too! If you are taking care of your depression and anxiety, this will do more for your child's neurobehavioral development than anything else you could do.

    Please call us at the InfantRisk Center if this has not completely answered your question. (806)352-2519

    -James Abbey, MD

    The following references may be useful to your physician if he or she needs more information:

    Castberg I, Spigset O. Excretion of Escitalopram in Breast Milk. J Clin Psychopharm 2006; 26(5):536-538.
    Rampono J, Hackett LP, Kristensen JH, Kohan R, Page-Sharp M, Ilett KF. Transfer of escitalopram and its metabolite demethylescitalopram into breastmilk. Br J Clin Pharmacol 2006; 62(3):316-322.
    Bellantuono C, Bozzi F, Orsolini L. Safety of escitalopram in pregnancy: a case series. Neuropsychiatric Disease and Treatment 2013:9:1333-37.


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