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Antidepressants in breast milk; comparative analysis of excretion ratios

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Abstract

Despite increasing prescription rates of antidepressants in pregnant and breastfeeding women over the past decades, evidence of drug exposure for neonates through lactation is very sparse. Concentrations of three antidepressants citalopram, sertraline, and venlafaxine were measured in maternal blood and breast milk in 17 women receiving antidepressant therapy during breastfeeding period. We also computed concentration-by-dose-ratios (C/D) and milk to serum (plasma) penetration ratios (M/P). Non-parametric tests were applied. Serum concentration of citalopram and daily dosage correlated positively while daily dosage and mother milk concentration did not (rho = 0.939, p = 0.005, and rho = 0.772, p > 0.05 respectively). A significant correlation was also found between serum and milk concentrations (rho = 0.812, p = 0.05). Venlafaxine daily dosage correlated positively with the active moiety milk concentration (rho = 0.949, p = 0.014). No significant correlations were reported for sertraline. The amount of antidepressant concentrations to which neonates may be exposed, assessed as absolute infant dose (AID), was particularly low with the highest median AID being 0.16 mg/kg/day for venlafaxine. No significant difference was detected for the M/P ratios between different drugs (p > 0.05), whereas the comparison of C/D ratios revealed lower values in the sertraline group, with the highest values reported for citalopram group (p = 0.007 for serum concentrations and p = 0.008 for mother milk). Findings suggest that breastfeeding under antidepressant treatment constantly exposes children with measurable drug concentrations. As daily dosage and serum concentration of the antidepressants did not predict drug concentrations in mother milk, measuring of drug concentrations in milk helps to quantify drug exposure during breastfeeding. More data—even data of drug concentrations in breastfed children—are needed to better assess the effects of drug exposure on children’s development.

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Acknowledgements

The authors wish to express their gratitude to the number of people from the Department of Gynecology and Obstetrics, RWTH Aachen University who support the ongoing study by identifying pregnant and nursing women receiving psychotropic drugs. So special thanks goes to the whole wonderful team of midwifes and to Dr. Rebecca Caspers, MU, Dr. Tomáš Kupec, and Bartlomiej Berger.

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Authors and Affiliations

  1. Department of Psychiatry, Psychotherapy and Psychosomatics, RWTH Aachen University, Pauwels Str. 30, 52074, Aachen, Germany

    Georgios Schoretsanitis, Marc Augustin & Michael Paulzen

  2. JARA – Translational Brain Medicine, RWTH Aachen University, Pauwels Str. 30, 52074, Aachen, Germany

    Georgios Schoretsanitis, Marc Augustin & Michael Paulzen

  3. University Hospital of Psychiatry, Bern, Switzerland

    Georgios Schoretsanitis

  4. Department of Gynecology and Obstetrics, RWTH Aachen University, Aachen, Germany

    Helena Saßmannshausen & Cordula Franz

  5. Department of Molecular Neuroimaging, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany

    Gerhard Gründer

  6. Alexianer Hospital Aachen, Aachen, Germany

    Michael Paulzen

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  1. Georgios Schoretsanitis
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Correspondence to Georgios Schoretsanitis.

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Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained by all patients participating in this study.

Conflict of interest

Gerhard Gründer has served as a consultant for Boehringer Ingelheim (Ingelheim, Germany), Cheplapharm (Greifswald, Germany), Eli Lilly (Indianapolis, Ind, USA), Lundbeck (Copenhagen, Denmark), Ono Pharmaceuticals (Osaka, Japan), Roche (Basel, Switzerland), Servier (Paris, France), and Takeda (Osaka, Japan). He has served on the speakers’ bureau of Eli Lilly, Gedeon Richter (Budapest, Hungary), Janssen Cilag (Neuss, Germany), Lundbeck, Roche, Servier, and Trommsdorf (Aachen, Germany). He has received grant support from Boehringer Ingelheim and Roche. He is co-founder of Pharma Image GmbH (Düsseldorf, Germany) and Brainfoods UG (Selfkant, Germany). Georgios Schoretsanitis received a grant from the bequest “in memory of Maria Zaoussi,” State Scholarships Foundation, Greece, for clinical research in Psychiatry for the academic year 2015–2016. The authors declare that they have no conflict of interest.

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Schoretsanitis, G., Augustin, M., Saßmannshausen, H. et al. Antidepressants in breast milk; comparative analysis of excretion ratios. Arch Womens Ment Health 22, 383–390 (2019). https://doi.org/10.1007/s00737-018-0905-3

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  • DOI: https://doi.org/10.1007/s00737-018-0905-3

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