IDEAS home Printed from https://ideas.repec.org/a/gam/jijerp/v21y2024i5p551-d1383916.html
   My bibliography  Save this article

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

Author

Listed:
  • Georgios Eleftheriou

    (Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy
    Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy)

  • Riccardo Zandonella Callegher

    (Italian Society of Psychiatry (SIP), Piazza Santa Maria della Pietà 5, 00135 Rome, Italy
    Psychiatry Unit, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
    UCO Clinica Psichiatrica, Azienda Sanitaria Universitaria Giuliano-Isontina, 34148 Trieste, Italy)

  • Raffaella Butera

    (Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy
    Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy)

  • Marco De Santis

    (Italian Society of Obstetrics and Gynecology (SIGO), Via di Porta Pinciana 6, 00187 Rome, Italy
    Department of Obstetrics and Gynecology, Fondazione Policlinico Universitario A. Gemelli, 00168 Rome, Italy)

  • Anna Franca Cavaliere

    (Italian Society of Obstetrics and Gynecology (SIGO), Via di Porta Pinciana 6, 00187 Rome, Italy
    Department of Gynecology and Obstetrics, Fatebenefratelli Gemelli, Isola Tiberina, 00186 Rome, Italy)

  • Sarah Vecchio

    (Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy
    Addiction Centre, Ser.D, Local Health Unit, 28100 Novara, Italy)

  • Cecilia Lanzi

    (Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy
    Division of Clinic Toxicology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy)

  • Riccardo Davanzo

    (Italian Society of Neonatology (SIN), Corso Venezia 8, 20121 Milan, Italy
    Maternal and Child Health Institute IRCCS “Burlo Garofolo”, 34137 Trieste, Italy
    Task Force on Breastfeeding, Ministry of Health, 00144 Rome, Italy)

  • Giovanna Mangili

    (Italian Society of Neonatology (SIN), Corso Venezia 8, 20121 Milan, Italy
    Department of Neonatology, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy)

  • Emi Bondi

    (Italian Society of Psychiatry (SIP), Piazza Santa Maria della Pietà 5, 00135 Rome, Italy
    Department of Psychiatry, ASST Papa Giovanni XXIII, 24100 Bergamo, Italy)

  • Lorenzo Somaini

    (Ser.D Biella, Drug Addiction Service, 13875 Biella, Italy
    Italian Society of Addiction Diseases (S.I.Pa.D), Via Tagliamento 31, 00198 Rome, Italy)

  • Mariapina Gallo

    (Poison Control Center, Hospital Papa Giovanni XXIII, 24127 Bergamo, Italy
    Italian Society for Drug Addiction (SITD), Via Roma 22, 12100 Cuneo, Italy)

  • Matteo Balestrieri

    (Psychiatry Unit, Department of Medicine (DAME), University of Udine, 33100 Udine, Italy
    Italian Society of Neuropsychopharmacology (SINPF), Via Cernaia 35, 00158 Rome, Italy)

  • Guido Mannaioni

    (Italian Society of Toxicology (SITOX), Via Giovanni Pascoli 3, 20129 Milan, Italy
    Division of Clinic Toxicology, Azienda Ospedaliera Universitaria Careggi, 50134 Florence, Italy
    Italian Society of Pharmacology, Via Giovanni Pascoli, 3, 20129 Milan, Italy)

  • Guglielmo Salvatori

    (Italian Society of Pediatrics, Via Gioberti 60, 00185 Rome, Italy
    Department of Medical and Surgical Neonatology Ospedale Pediatrico Bambino Gesù, 00165 Rome, Italy)

  • Umberto Albert

    (Italian Society of Psychiatry (SIP), Piazza Santa Maria della Pietà 5, 00135 Rome, Italy
    UCO Clinica Psichiatrica, Azienda Sanitaria Universitaria Giuliano-Isontina, 34148 Trieste, Italy
    Italian Society of Neuropsychopharmacology (SINPF), Via Cernaia 35, 00158 Rome, Italy
    Department of Medicine, Surgery and Health Sciences, University of Trieste, 34128 Trieste, Italy)

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.

Suggested Citation

  • Georgios Eleftheriou & Riccardo Zandonella Callegher & Raffaella Butera & Marco De Santis & Anna Franca Cavaliere & Sarah Vecchio & Cecilia Lanzi & Riccardo Davanzo & Giovanna Mangili & Emi Bondi & Lo, 2024. "Consensus Panel Recommendations for the Pharmacological Management of Breastfeeding Women with Postpartum Depression," IJERPH, MDPI, vol. 21(5), pages 1-27, April.
    • Handle: RePEc:gam:jijerp:v:21:y:2024:i:5:p:551-:d:1383916
    as

    Download full text from publisher

    File URL: https://www.mdpi.com/1660-4601/21/5/551/pdf
    Download Restriction: no
    File URL: https://www.mdpi.com/1660-4601/21/5/551/
    Download Restriction: no
    ---><---

    References listed on IDEAS

    as
    1. Sarah Kittel-Schneider & Ethel Felice & Rachel Buhagiar & Mijke Lambregtse-van den Berg & Claire A. Wilson & Visnja Banjac Baljak & Katarina Savic Vujovic & Branislava Medic & Ana Opankovic & Ana Fons, 2022. "Treatment of Peripartum Depression with Antidepressants and Other Psychotropic Medications: A Synthesis of Clinical Practice Guidelines in Europe," IJERPH, MDPI, vol. 19(4), pages 1-17, February.
    2. Kaci Bohn & Alejandra Fernandez & Stephanie Stroever & Dara O’Neil & Joan Enderle & Kaytlin Krutsch, 2023. "Mixing Meds and Milk: Evaluation of a Performance Gap Intervention for Provider Education in Breastfeeding and Maternal Medication Use," IJERPH, MDPI, vol. 20(19), pages 1-15, September.
    3. Khazaie, Habibolah & Rezaie, Leeba & Shahdipour, Niloofar & Weaver, Patrick, 2016. "Exploration of the reasons for dropping out of psychotherapy: A qualitative study," Evaluation and Program Planning, Elsevier, vol. 56(C), pages 23-30.
    4. Georgios Eleftheriou & Riccardo Zandonella Callegher & Raffaella Butera & Marco De Santis & Anna Franca Cavaliere & Sarah Vecchio & Alessandra Pistelli & Giovanna Mangili & Emi Bondi & Lorenzo Somaini, 2023. "Consensus Panel Recommendations for the Pharmacological Management of Pregnant Women with Depressive Disorders," IJERPH, MDPI, vol. 20(16), pages 1-57, August.
    Full references (including those not matched with items on IDEAS)

    Most related items

    These are the items that most often cite the same works as this one and are cited by the same works as this one.

      Corrections

      All material on this site has been provided by the respective publishers and authors. You can help correct errors and omissions. When requesting a correction, please mention this item's handle: RePEc:gam:jijerp:v:21:y:2024:i:5:p:551-:d:1383916. See general information about how to correct material in RePEc.

      If you have authored this item and are not yet registered with RePEc, we encourage you to do it here. This allows to link your profile to this item. It also allows you to accept potential citations to this item that we are uncertain about.

      If CitEc recognized a bibliographic reference but did not link an item in RePEc to it, you can help with this form .

      If you know of missing items citing this one, you can help us creating those links by adding the relevant references in the same way as above, for each refering item. If you are a registered author of this item, you may also want to check the "citations" tab in your RePEc Author Service profile, as there may be some citations waiting for confirmation.

      For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: MDPI Indexing Manager (email available below). General contact details of provider: https://www.mdpi.com .

      Please note that corrections may take a couple of weeks to filter through the various RePEc services.

      IDEAS is a RePEc service. RePEc uses bibliographic data supplied by the respective publishers.