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 pharmacologic treatment in women who are breast-feeding, adverse effects may be greater in babies who are premature, very young, systemically ill, and those with liver or kidney impairment; discussion with a pediatrician is recommended before prescribing a psychotropic drug to a breast-feeding mother in these circumstances.[169] As with all drugs taken during breast-feeding, 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 breast-feeding in relation to the timing of maternal drug administration; this type of recommendation may add to the difficulties of initiating breast-feeding.[91] There is limited evidence regarding the safety and efficacy of St John’s wort in women who are breast-feeding; therefore, it is advisable to recommend that women consider an alternative medication with greater evidence in breast-feeding.[170]
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