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The most recent Report on Confidential Enquiries into Maternal Deaths/Maternal and Child Health has highlighted the risk of postnatal depression and its potential to lead to postnatal psychosis and suicide. There are numerous case reports offering conflicting advice about the use of psychotropic drugs in lactating women. The tricyclic antidepressants amitriptyline, nortriptyline and desipramine are all excreted into breast milk, with the baby being exposed to approximately 1% of the maternal dose. This poses a theoretical risk for the infant, but there are no case reports of adverse effects, and the balance of risks is generally believed to favour continuing treatment of the mother and allowing breastfeeding. Information about the selective serotonin reuptake inhibitors (SSRIs) in lactation is limited. The drugs are excreted into breast milk, but there are no controlled

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studies investigating effects on the infant. The manufacturer's data sheet states that fluoxetine should not be given to nursing mothers.

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