Antidepressant use by the breastfeeding mother: Clinical and economic consequences

Abstract

There is a paucity of data on the consequences of antidepressant use in breastfeeding women, compared to leaving the depression untreated, making it difficult to weigh the risk and benefits of both options to mother and child. Thus, the health and healthcare costs of depressed, breastfeeding women treated with antidepressants (AD(+)), and their infants were compared to those forgoing pharmacotherapy (AD(-)), and to healthy women (COMP) for the first year postpartum. The validity of maternal report of healthcare utilization, and the reliability of report of infant feeding methods were also examined. Mother-infant pairs were interviewed over the first year postpartum. The Edinburgh Postnatal Depression Scale (EPDS), Short Form 36 (SF-36), and Functional Status II- Revised (FS-II(R)) were used to assess maternal depression, and maternal and infant well-being, respectively. Fifty-five, 34, and 60 AD(+), AD(-), and COMP women, respectively, completed the study. EPDS scores differed between the groups; (AD(+): 6.5, AD(-): 10.5, COMP: 3.7, p<0.01), suggesting more depressive symptomatology in AD(-). AD(+) scores were higher than COMP, suggesting inadequate treatment. SF-36 mental component scores (AD(+): 49.8, AD(-) 45.8, COMP: 55.5, p<0.01) indicated more functional impairment in AD(-) women. The annual average costs per mother-infant pair from the provincial ministry of health perspective differed between the groups (AD(+): $1488.36, AD(-): $2054.54, COMP: $1082.29, p<0.05). From the societal perspective, both depressed groups incurred greater costs compared to COMP (AD(+): $3730.48, AD(-): $4129.45, COMP:$2757.41, p<0.01). Although depressed groups incurred greater costs and had poorer outcomes compared to the COMP, AD(+) women were achieving better outcomes compared to AD(-) without incurring greater costs. Although remote risks of exposure to the nursed infant cannot be dismissed, given the clinical and economic benefits found in the study, postpartum women with depression should not be discouraged from pharmacotherapy, even while breastfeeding. Maternal self-report and report of infant health care utilization were compared to administrative records. No differences existed in agreement between data sources between reports by depressed mothers, and COMP mothers. Finally, maternal recall of infant feeding method over time was accurate for breastfeeding and formula feeding status, but less so for age when solids were introduced.