From the Guidelines
Sertraline (Zoloft) is the safest SSRI during breastfeeding, with minimal transfer into breast milk and the most research supporting its safety. According to the study by 1, sertraline is one of the SSRIs that is minimally excreted in human milk and provides the infant with less than 10% of the maternal daily dose, normalized for weight. The study by 1 also supports this, stating that sertraline is thought to transfer in lower concentrations and produce undetectable infant plasma levels.
Key Points to Consider
- The typical starting dose of sertraline is 25-50 mg daily, which can be increased gradually if needed to 50-200 mg daily.
- Paroxetine (Paxil) and fluvoxamine also have low transfer rates into breast milk but have less research behind them.
- Fluoxetine (Prozac) and citalopram/escitalopram (Celexa/Lexapro) have higher transfer rates and longer half-lives, making them less ideal choices.
- When taking any SSRI while breastfeeding, it is essential to monitor the baby for unusual irritability, poor feeding, or sleep disturbances.
- The benefits of treating maternal depression typically outweigh the minimal risks to the breastfed infant, as untreated depression can negatively impact mother-infant bonding and child development, as noted by 1 and 1.
Monitoring and Precautions
- Always discuss medication choices with a healthcare provider to make an individualized decision based on specific situation and medical history.
- Be aware of the potential adverse effects in infants exposed to SSRIs via breast milk, such as irritability and decreased feeding, although these effects are nonspecific and have been documented only in case reports, as mentioned in 1.
From the Research
Safest SSRI During Breastfeeding
- The safest SSRI during breastfeeding is a topic of interest for many researchers and clinicians, with several studies providing evidence on the safety of various SSRIs 2, 3, 4, 5.
- According to a study published in 2018, sertraline is one of the safest antidepressants during breastfeeding, and women already taking sertraline should be advised to breastfeed and continue the medication, starting with low doses and increasing slowly while monitoring the newborn for adverse effects 2.
- A systematic review published in 2015 found that sertraline and paroxetine show a better neonatal safety profile during breastfeeding compared to other SSRIs, and that paroxetine and sertraline should be preferred as first-line choice in nursing women who need an antidepressant treatment 3.
- Another study published in 2017 found that sertraline and citalopram should be first-line drug treatments for anxiety and depression in pregnant women, and that sertraline can be continued in breast-feeding as the concentration found in breast milk is very low and has not been linked to infant complications 4.
- A meta-analysis published in 2015 found that sertraline is a first-line drug for breastfeeding women due to documented low levels of exposure in breastfeeding infants and very few adverse events described in case reports, and that routine serum sampling or genotyping is not warranted for breastfeeding mothers taking sertraline and/or their infants 5.
Key Findings
- Sertraline is considered one of the safest SSRIs during breastfeeding due to its low levels of exposure in breastfeeding infants and few adverse events described in case reports 2, 3, 4, 5.
- Paroxetine is also considered a safe option for breastfeeding women, with a better neonatal safety profile compared to other SSRIs 3.
- Citalopram is another option that can be considered safe for breastfeeding women, although more research is needed to confirm its safety profile 4.
- The concentration of sertraline in breast milk is very low and has not been linked to infant complications, making it a good option for breastfeeding women 4, 5.