Monitoring
Review women regularly during treatment to ensure that they are responding. The frequency of review depends on both the severity of the depression and the individual treatment used; particularly close monitoring of mood is required for women prescribed antidepressants, in case treatment triggers a hypomanic or manic episode (e.g., due to undiagnosed bipolar disorder).
During pharmacological treatment in women who are breastfeeding, adverse effects may be greater in babies who are premature, very young, systemically unwell, and those with liver or kidney impairment; discussion with a paediatrician is recommended before prescribing a psychotropic drug to a breastfeeding mother in these circumstances.[172] As with all drugs taken during breastfeeding, monitor the infant regularly for sedation, irritability, and any alteration in sleep, feeding, or growth pattern.[91] There is little evidence to support disposing of breast milk or timing breastfeeding in relation to the timing of maternal drug administration; this type of recommendation may add to the difficulties of initiating breastfeeding.[91] There is limited evidence regarding the safety and efficacy of St John’s wort in women who are breastfeeding; therefore, it is advisable to recommend that women consider an alternative medication with greater evidence in breastfeeding.[173]
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