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Another systematic review and comprehensive analysis indicated that antidepressants vary in their ability to enter amniotic fluid, cord blood, and breast milk, with citalopram having the highest permeability (mean permeability of active molecules: 2.03, range: 0.356.97) and fluoxetine having the lowest permeability (mean permeability of active molecules: 0.11, range: 0.020.20) (Schoretsanitis et al., 2021)

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Since all Medicare Advantage and Medicare Part D plans are privately operated, many plans that are allowed to cover these drugs might still exclude them, both to avoid the cost of the medications and to avoid adverse selection, where the plan covering these might recruit members with higher risks