From the Guidelines
Zoloft (sertraline) is generally considered safe during breastfeeding, with low levels of the medication passing into breast milk, resulting in minimal exposure to the infant. According to a study published in the American Family Physician in 2015 1, sertraline and paroxetine transfer to breast milk in lower concentrations than other antidepressants, making them a preferred choice for nursing mothers. Another study published in Pediatrics in 2012 1 also found that sertraline is minimally excreted in human milk and provides the infant with less than 10% of the maternal daily dose, normalized for weight.
When using Zoloft while breastfeeding, it's essential to monitor the baby for any unusual symptoms, such as excessive sleepiness, feeding difficulties, or irritability, although these are rare. The benefits of treating maternal depression typically outweigh the minimal risks to the breastfed infant, as untreated depression can negatively impact both mother and baby. If concerns arise, taking the dose immediately after nursing or before the baby's longest sleep period can further minimize exposure.
It's crucial to discuss with a healthcare provider before starting, stopping, or changing any medication during breastfeeding, as individual circumstances may vary. The American Academy of Pediatrics recommends that clinicians be aware of the potential risks and benefits of SSRI use during lactation and counsel mothers accordingly 1. Overall, the available evidence suggests that Zoloft can be a safe and effective treatment option for breastfeeding mothers with depression, when used under the guidance of a healthcare provider.
From the FDA Drug Label
are breast-feeding or plan to breast-feed. Some sertraline may pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby while taking sertraline. The FDA drug label does not provide sufficient information to determine the safety of Zoloft in breastfeeding. However, it does mention that some sertraline may pass into breast milk. To make a conservative clinical decision, it is recommended to consult a healthcare provider to discuss the potential risks and benefits of taking sertraline while breastfeeding 2.
From the Research
Safety of Zoloft in Breastfeeding
- Zoloft, also known as sertraline, is considered one of the safest antidepressants during breastfeeding 3.
- The World Health Organization recommends breastfeeding, and sertraline can be used during this time with careful monitoring of the newborn for adverse effects such as irritability, poor feeding, or uneasy sleep 3.
- The selective serotonin reuptake inhibitors (SSRIs) sertraline and paroxetine are present in low levels in breast milk and are considered preferred agents during lactation 4.
Precautions and Recommendations
- Women taking sertraline should start with low doses and slowly increase the dose, with careful monitoring of the newborn for adverse effects 3.
- The target dose should be the lowest effective dose, and child exposure to the medication may be reduced by avoiding breastfeeding at the time when the antidepressant milk concentration is at its peak 3.
- A decision to switch to sertraline from ongoing and effective treatment should be taken only after a scrupulous evaluation of the potential risks and benefits of switching versus continuing the ongoing medication while monitoring the infant carefully 3.
Comparison with Other Antidepressants
- Most antidepressants are considered relatively safe to use during breastfeeding, but the safety data for other antidepressants varies 4.
- Monoamine oxidase inhibitors (MAOIs) should generally be avoided during breastfeeding due to potential risks to the infant 4.
- Antidepressant and antipsychotic drugs are generally considered to be relatively safe when used during pregnancy or breastfeeding, but benzodiazepine drugs have a small but significant risk of birth defects 5.