Sertraline Safety During Breastfeeding
Yes, sertraline is safe to take while breastfeeding and is recommended as a first-line antidepressant for postpartum mothers who need treatment for depression. 1
Why Sertraline is the Preferred Choice
Sertraline stands out among antidepressants for breastfeeding mothers due to its favorable pharmacokinetic profile:
Minimal breast milk excretion: Sertraline provides the infant with less than 10% of the maternal daily dose, making it one of the safest options during lactation. 1
Undetectable or very low infant plasma levels: In a recent pharmacokinetic study, sertraline was undetectable in the plasma of all 15 breastfed infants whose mothers were taking the medication, despite being present in all breast milk samples. 2
Low infant-to-maternal plasma concentration ratios: This favorable ratio minimizes actual drug exposure to the nursing infant. 1
Practical Prescribing Approach
Start low and titrate slowly to minimize any potential infant exposure:
Begin with 25-50 mg daily and gradually increase the dose while carefully monitoring the newborn. 1
Use the lowest effective dose that adequately controls maternal symptoms. 3
Continue breastfeeding if already taking sertraline—do not discontinue either the medication or breastfeeding, as the benefits of both outweigh minimal risks. 1, 3
Infant Monitoring Guidelines
Watch for these signs in the breastfed infant, particularly during the first weeks of treatment:
- Irritability, jitteriness, or excessive crying 3
- Poor feeding or feeding difficulties 3
- Uneasy sleep or sleep disturbances 3
- Adequate weight gain and developmental milestones 1
Higher vigilance is needed if the infant was born premature or had low birth weight, as these infants may be more vulnerable to drug effects. 3
Important Clinical Caveats
The risk of untreated maternal depression far exceeds the minimal risk of sertraline exposure through breast milk. Untreated postpartum depression poses significant risks to both mother and infant, including impaired mother-infant bonding, decreased breastfeeding initiation, and harm to infant development. 1
Avoid switching medications unnecessarily: If a mother is already on a different effective antidepressant, switching to sertraline should only occur after careful risk-benefit analysis, as medication changes carry their own risks of relapse. 3
Timing of breastfeeding: When feasible, infant exposure can be further minimized by avoiding breastfeeding during peak milk concentration times (typically 7-10 hours after the maternal dose), though this is not usually necessary given the already low transfer rates. 3, 4
Comparative Safety Data
Sertraline and paroxetine are considered the two most suitable first-line agents for breastfeeding mothers, with sertraline often preferred due to its extensive safety data. 1, 5, 2 Other SSRIs like fluoxetine and citalopram have higher infant plasma levels and more reported adverse effects, making them less ideal choices. 5, 6, 4
FDA Labeling Considerations
The FDA label notes that "it is not known whether, and if so in what amount, sertraline or its metabolites are excreted in human milk" and recommends caution. 7 However, this conservative language reflects regulatory requirements rather than clinical evidence—the extensive published data clearly demonstrates that sertraline transfer is minimal and clinical outcomes in breastfed infants are excellent. 1, 2