Introduction: Antidepressant drugs are used frequently in psychiatric disorders. It has been reported that almost all antidepressant agents can pass into human breast milk. However, the information concerning the clinical use in breastfeeding woman of these agents is limited. This case report presents the gastrointestinal side effects in an infant of mother treated with low-dose şuvoxamine.
Case: A 40-year-old breastfeeding woman was admitted to the psychiatry outpatient clinic of a university hospital with complaints severe anxiety, decreased sleep, anhedonia and depressive mood. She had a 5-month year-old baby. She had a history of use of venlafaxine 75 mg/day due to major depressive disorder during 6 months prior to the last pregnancy. A psychiatrist discontinued the treatment, because the patient did not have marked depressive symptoms during pregnancy. The patient described that depressive symptoms occurred again at postpartum 6th week. Eight weeks later the patient has applied to a psychiatrist for her depressive symptoms. Paroxetine 20 mg/day and sertraline 50 mg/day were administered to the patient respectively, but, these were discontinued, because it was observed several side effects in the patient (e.g, tachycardia, marked increase in anxiety, nausea, vomiting and complete loss in sleep). She described no side effect in baby due to these drugs. Psychiatric interview performed by the Structured Clinical Interview for DSM-IV (SCID-I) indicated that the patient had currently Major Depression. We started 50 mg/day şuvoxamine. Two days later, she reported that severe diarrhea and mild vomiting were emerged in her baby following şuvoxamine use. There was no any side effect in mother. The examination of baby by a pediatricianand laboratuary tests including hemogram, analysis of stooland biochemistry suggested that the baby did not have any illness related to the gastrointestinal symptoms. Following discontinue of şuvoxamine; the gastrointestinal symptoms observed in baby were completely resolved without any specific treatment within 48 hours.
Discussion: According to ACOG Practice Bulletin, the SSRIs including şuvoxamine, sertraline and paroxetine are safer than venlafaxine in breastfeeding women. Paroxetine and sertraline are intolerable for the present mother, therefore, we started low-dose şuvoxamine but severe gastrointestinal side effects emerged in baby. Although available limited data reported that there is no marked adverse effect of şuvoxamine on baby of breastfeeding women , the present case suggests that some babies may be inşuenced adversely by maternal use of şuvoxamine. Clinical trials with large sample highlighting the importance of this subject are required.