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s reported by existing studies of SSRIs. Nor fluoxetine, the active component of fluoxetine, may accumulate in the serum of breastfeeding infants due to its long half-life. Studies have reported various adverse effects including colic, crying, lower body weight, fussiness, and seizures. However, they reported no abnormal effects although most studies indicate low concentrations of the drug in breast milk and infant serum. Low concentration levels may be too weak to stimulate malformations.

The evidence for sertraline, paroxetine, fluvoxamine, and citalopram is mixed. Like fluoxetine, these SSRIs were generally detected in low concentrations, with generally no adverse effects. Fluvoxamine has been found to be an effective remedy for postnatal depression. Overall, the evidence base for SSRIs other than fluoxetine was too scant to warrant firm conclusions about their impact on postnatal depression.

Figure 6 Number of infants and adverse events reported for various SSRIs (Misery & Kostas’s, 2002)

Figure 7 Number of infants and adverse events reported for various TCAs (Misery & Kostas’s, 2002)

Research findings on TCAs are summarised in Figure 7. Like SSRIs, Tasted to be found in low concentrations in breast milk and serum. Doxepin has been shown to produce abnormalities (respiratory depression, muscle hypotonic, jaundice, vomiting, poor sucking, and drowsiness). However other TCAs – amitriptyline, clomipramine, desipramine, imipramine and nortriptyline - do not appear to produce any adverse health outcomes. The negative effects of doxepin are attributed to the long half-life of its active metabolite, so use of this TCA is generally not recommended. Literature on other depressants was also considered.

Hendricks (2003) comments on literature concerning the effectiveness of antidepressants and psychotherapeutic interventions. She argues that postnatal depression is often overlooked in paediatric clinics. Her review highlights the paucity of randomised controlled trials on the impact of antidepressants on depressive symptomatology. One study was found in this regard (see Appleby et al, 1997). This investigation showed that an antidepressant – fluoxetine – was no more effective than cognitive behaviour therapies.

Other studies suggest that sertraline, paroxetine, venlafaxine, and nortriptyline generally have no adverse health outcomes, although some reports suggest fluoxetine can induce sleeplessness and irritability. Furthermore, there is a paucity of literature on the long-term effects of antidepressants. By contrast, psychotherapeutic treatments have been found to be both highly acceptable and effective.

Nevertheless Hendricks (2003) concluded that antidepressants can be helpful and need not necessitate suspension of breastfeeding. Overall the review is rather limited in scope (only 12studies are cited) and hence the reliability of her deductions may be questionable. However, the conclusions seem to concur with more comprehensive literature reviews discussed here.

Bennett et al (2004) reviewed evidence on the use of antidepressants for treatment of post-natal depression. The review focused on clinical本论文由英语论文网提供整理，提供论文代写，英语论文代写，代写论文，代写英语论文，代写留学生论文，代写英文论文，留学生论文代写相关核心关键词搜索。