Antidepressants and breastfeeding behaviors: a systematic review.

OBJECTIVE: To assess whether antidepressant exposure during pregnancy or postpartum is associated with changes in breastfeeding behaviors STUDY DESIGN: Systematic review of interventional and observational studies; outcomes grouped as initiation/status at discharge, preterm/NICU contexts, duration, and nighttime feeding. RESULTS: Late-pregnancy exposure was consistently associated with lower initiation and reduced breastfeeding at discharge. In settings with intensive lactation support - such as among mothers of preterm infants or in NICUs-differences between exposed and unexposed dyads were small or nonsignificant. Effects on duration were context-dependent: in countries with high baseline breastfeeding, antenatal exposure was not linked to shorter duration and sometimes coincided with less early cessation; where baseline rates were lower, exposure was associated with earlier cessation. Evidence on nighttime feeding was sparse. CONCLUSION: When antidepressant treatment is indicated, optimizing breastfeeding requires integrated perinatal care combining psychiatric monitoring, individualized medication counseling, and proactive lactation support. Prospective studies disentangling pharmacological from contextual effects are needed.