Antidepressant medications, like nearly all medications,  can have unwanted side effects

Antidepressants can interact with other medications, including over-the-counter medications and herbal remedies

St. John's Wort (hypericum) is an herbal remedy used by some to help relieve the symptoms of depression

Caution mothers to discuss any medications they are taking (prescribed, over-the-counter and/or herbal) with their physician before taking the medications along with their antidepressant

Mom's who take SSRIs during the pregnancy deliver infants who experience a 3 to 4-fold increase Neonatal Abstinence Syndrome (NAS) symptoms

	Most common symptoms include: Restlessness Gastrointestinal problems Tremors Hypertonicity (abnormal increase in muscle tone) Sleep disturbances High-pitched cry
	Most infants do not require treatment and symptoms significantly subside by 2 weeks of age
	Symptoms generally disappear by 2 months of age; even in the breastfeeding infant
	Recommendations If SSRIs indicated during pregnancy, minimum number of drugs at the minimum dose that are effective be prescribed for mom Monitor infant for 48 hours after birth for appearance of NAS

Additional information/research needed to determine short- and long-term effects of antidepressants on infants, especially breastfeeding infants

Remember:  The FDA recently issued an alert regarding Paxil and the increased risk of birth defects and heart defects to the fetus if the drug is taken during the 1st trimester

Use safest possible medication, most excreted in breastmilk

Weigh benefits of breastfeeding vs. risks of medication exposure

Obtain periodic antidepressant blood levels in the infant to determine efficacy of metabolism and excretion

Observe infant for behavioral changes (NAS symptoms)

Arrange mother's dosing schedule at times when the infant is least likely to be exposed

Allow mom maximum time to metabolize and excrete the drug before the next breastfeeding