Peter S. Bernstein, MD, MPH, FACOG; Francine H. Einstein, MD

Disclosures

August 21, 2003

Question

What, if any, adverse impacts does the antidepressant Zoloft have on lactation? The patient is experiencing depression and had intended to breast-feed through to 12 months rather than end at 9 months.

Response from Peter S. Bernstein, MD, MPH, FACOG and Francine H. Einstein, MD

The postnatal period can present a complicated problem for women with depressive disorders and their healthcare providers. Mothers who need antidepressant treatment may wish to breast-feed their infants but are reluctant to take any medications while lactating for fear that the medication will have harmful effects on their infants. Sertraline, the generic form of Zoloft, is a commonly used medication, which belongs to the selective serotonin reuptake inhibitor group of antidepressants. Its predominant action is inhibition of the presynaptic reuptake of serotonin from the synaptic cleft. It has been used in the treatment of major depressive disorder, panic disorder, obsessive-compulsive disorder, and posttraumatic stress disorder. Sertraline is present in the breast milk of lactating women taking this medication. However, the levels of sertraline and its metabolite, N-desmethylsertraline, found in the breast milk of these mothers is very low.[1] There are no published controlled studies on the use of sertraline by breast-feeding women. The basis of our knowledge about sertraline and lactation stems from publications of case reports, case series, and pharmacokinetic studies. No major adverse events have been reported in infants exposed to sertraline through breast milk.[2] The growing body of literature suggests that sertraline at doses of 50-150 mg/day is safe in lactating women with depressive disorders who require pharmacologic treatment. Healthcare providers must evaluate each case on an individual basis and explore other nonpharmacologic therapies when faced with the decision to prescribe sertraline to the breast-feeding mother.

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