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Zoloft and Breastfeeding - Is it Safe?

Looking for The Lactivist? She's retired. But you CAN still find Jen blogging. These days, she's runs A Flexible Life. Join her for life, recipes, projects and the occasional rant.

Tuesday, December 20, 2005

With millions of Americans now being prescribed Zoloft, I'm starting to see questions pop up in forums and discussion groups about whether or not it is safe to take Zoloft while breastfeeding. Since Zoloft is the number one prescribed brand in its market and is being used to treat Premenstrual Dysphoric Disorder (PMDD), this is probably an issue worth looking into for many moms that plan to nurse.

Since formula is a readily available alternative, many doctors will encourage moms to simply bypass breastfeeding if they are taking a prescription like Zoloft to treat things like postpartum depression or PMDD. Here at The Lactivist blog, we're trying to help moms make better decisions and get the information that they need, so I decided to do some looking into the Zoloft and breastfeeding issue to see what I could make of it.

(NOTE: I'm not a doctor - always talk to your doctor about drugs like Zoloft and their impact on breastfeeding. I'm just trying to share some resources. EDITED TO ADD: Dr. Thomas Hale has a great reference book that goes pretty in-depth on different drugs and breastfeeding: Medications and Mother's Milk: A Manual of Lactational Pharmacology)

According to research, very small amounts of Zoloft are found in the human breast milk of a nursing mother taking Zoloft. Studies show that about 1-2% of norsertraline, the breakdown product of Zoloft, are found in breast milk. It is generally agreed that taking Zoloft while breastfeeding does not have an adverse effect on nursing infants, but there haven't yet been any long-term studies, so the issue is still up for some debate.

Right now, many pediatricians will suggest that a mother take Zoloft right after breastfeeding, or when they know that their baby will be sleeping for a long period. Based on that, I can't help but wonder if it might also be worth considering exclusively pumping rather than nursing. I know that I was able to pump just three times a day while still keeping up with Elnora's needs and could often time my medications to just after I pumped to minimize the amount that would be left in my system the next time I pumped.

A study cited at iVillage says that tests on nursing mothers found that Zoloft was found at about the same rate in breast milk as it was in mother's blood stream. Zoloft levels in breastfed infants were too low to be detected. In fact, the iVillage article goes on to quote Dr. Jack Newman as stating "it is rare for the risk of breastfeeding (with added sertraline...) to outweigh the risk of formula." On the other hand, some doctors feel that since the full effects of Zoloft in breastfeeding infants are not yet known, it is best to avoid breastfeeding while taking Zoloft.

The choice really needs to be made by each mom and a doctor that she trusts, but there is support within the medical community that means that there are more options that simply forgoing Zoloft treatment or forgoing breastfeeding.

This is exactly the type of information that needs to continue to make its way into the mainstream so that more breastfeeding mothers have access to relevant information about how their medical choices impact their children.

Additional References if you are considering taking Zoloft while Breastfeeding:

American Academy of Pediatrics Committee on Drugs: The transfer of drugs and other chemicals into human milk. Pediatrics 108(3):776-789, 2001.

Epperson, C.N., Anderson, G.M., and McDougle C.J. Sertraline and breast-feeding (letter). N Engl J Med 336:1189-90, 1997.

Hendrick, V., et al. Use of sertraline, paroxetine and fluvoxamine by nursing women. British Journal of Psychiatry. 179:163-166, 2001.

Kristensen, J.H., et al. Distribution and excretion of sertraline and N-desmethylsertraline in human milk. Br J Clin Pharmacol 45:453-7, 1998.

Mammen, O.K, et al. Sertraline and norsertraline levels in three breastfed infants. J Clin Psychiatry 58:100-3, 1997.

Stowe Z.N., et al. Sertraline and desmethylsertraline in human breast milk and nursing infants. Am J Psychiatry 154:1255-60, 1997.

Wisner K.L., Perel J.M., and Blumer J. Serum sertraline and N-desmethylsertraline levels in breastfeeding mother-infant pairs. Am J Psychiatry 155:690-2, 1998.

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  1. Blogger the SmockLady | 3:20 PM |  

    I have always trusted the comments and studies of Dr. Thomas Hale and his annual books, Medications and Mothers' Milk. He has a Ph.D. in pharmacology and his phocus in life is this very study of all medications and any of effects in the breastmilk and the baby. Breastfeeding mothers should all know about him and his book and let their doctors know of him if they have questions.

    There was a medication that I was about to be prescribed when I reminded my doctor I was still breastfeeding 15 months post partum. He did not have the book, but his colleague did. He checked out the medication and prescribed something else for me. Dr. Hale also gives alternatives for varying medications.

  2. Blogger Jennifer | 6:51 PM |  

    Dr. Hale's book is on my wish list, I'd love to get a copy so that I can add some data to the site from it. I always just called up the milk bank while I was nursing to ask them about a particular medication.

  3. Anonymous Mama C-ta | 6:31 PM |  

    I take wellbutrin and always have concerns since there really hasn't been long term data for that either. Supposedly safe...today.

  4. Blogger K | 5:35 AM |  

    Excellent Post Lactivist! It breaks my heart every time I hear a mother say she stopped BF due to taking Z, or whenever I hear a mom obviously sufferring from depression or anxiety and won't get help because of misinformation about available meds and BF.

    Kelly

  5. Blogger Jennifer | 7:54 AM |  

    I've been thinking that it might be worth investing some of my Lactivist profits in the Hale book, just so I can write up some good content on all of these issues... Only problem is that you have to buy a new version each year...

    Anyone know if there's a web site that you can subscribe to for up to the minute updates? May have to go hunting for that today...

  6. Blogger Amanda | 1:55 PM |  

    Gracie likes her breastmlk spiked with a little bit of SSRIs. Keeps us both happy!

    Just kidding and in all seriousness, great post and thank you!

  7. Blogger Beth | 11:59 AM |  

    If there are so many women questioning it, and quite a few doing it, then why isn't there a comprehensive study going on?

  8. Blogger Jennifer | 1:15 PM |  

    that would be a question for the drug companies...

    The cynical side of me says why would they spend money on a study that may convince people NOT to use their drug?

  9. Anonymous Darla | 2:57 PM |  

    Thank you so much for your encouragement! I recently started taking it and found out that I was pregnant. I was worried that either I would have to forgo BF or stop taking the meds I need!

  10. Anonymous Anonymous | 7:49 AM |  

    I just started taking Zoloft yesterday. For the past 2 months I've been getting up in the middle of the night to pump. Last night, however, I did and I got less than 1/2 oz of breastmilk. Is this a side effect of Zoloft. And if so... is my breastmilk totally gone or can I get it back?

  11. Blogger Jennifer Laycock | 11:43 AM |  

    Anything is possible, but that seems awfully quick in terms of the medicine impacting your supply. Especially if you've already been pumping for awhile and have an established supply.

    There are no studies that list lowered milk supply as a side effect of Zoloft, but based on the chemicals in the drug, it's a possibility.

    My suggestion would be to find a good PRO-breastfeeding doctor and to ask their input. You might try looking up the email address for Dr. Jack Newman and emailing him.

    Either way, you can't and won't lose your milk supply overnight, so don't worry about that! It may go down over time if the medication has an impact, but if you've been nursing for at least a few months, you've got some time before you have to worry about having done irreversible harm to your supply.

    Good luck!

  12. Anonymous Anonymous | 10:24 AM |  

    Some women have problems pumping because breastfeeding is a very emotional and personal thing for them. I couldn't even pump a tablespoon out after the first 2 months of nursing, but I nursed my first child for 20 months. My breasts just wouldn't respond to the pump any longer.

  13. Anonymous Anonymous | 6:41 PM |  

    What a relief to find this site! I just weaned off Effexor and when I had a total meltdown my doctor switched me to Zoloft. I've been very worried about the effects on the baby and whether or not I'd be able to breastfeed and THERE IS HARDLY ANY INFO OUT THERE!! It is so reassuring to hear all of these women experiencing something similar and it turning out okay.

  14. Anonymous Anonymous | 7:41 PM |  

    I have been taking zoloft for 3 days and i have noticed a decrease in my milk supply, I think it could be related.I am upset because i have JUST enough milk as it is for her and I was not told this would be a side effect. If anyone els can post more info that would be great.

  15. Anonymous Anonymous | 10:06 AM |  

    I'm taking Zoloft,and I did through my whole pregnancy. I've been nursing for 3 months now, and everything seems to be going fine. Pray about it. :)

  16. Anonymous Anonymous | 6:07 AM |  

    I have taken Zoloft for 15 years. I took it while I was pregnant and while I breastfeed for a year with my first child. She is now 4 years old. She is fine. With my second pregnancy, I took Zoloft. During the 9th month, my doctor told me the insurance company would not ok my doctor to prescribe Zoloft. My OB prescribed it for me. However, now I'm breastfeeding my second child and I see that they have added information on my prescription that I should talk to the baby's doctor about taking this drug. So, what are the reasons for these new red flags.

  17. Anonymous Anonymous | 7:53 PM |  

    As to why there aren't studies being conducted - my doc made a great point: Those of us who need these medications are predisposed, so to speak; our genetics allow this to happen. It's impossible to design a study that could seperate the effects of using a drug like Zoloft from the outcomes caused by our kids' genetic inheritance. So, unless the effect of taking the drug while nursing was severe (which it isn't, at least not through adolescence), you'd never know to what degree an outcome (say, depression) was caused by the drug that a kid got when they were an infant versus what they woud've had anyway.

  18. Anonymous Anonymous | 12:05 PM |  

    we need updated info...this is 2008! have more studies been done?

  19. Blogger Amanda | 1:00 PM |  

    Note that my milk DID dry up when I started on a 50 mg dose. It was so scary. My baby was screaming and crying, and I wasn't having let downs. I stopped cold turkey after about a week, and took fenugreek to get it back up. Later on, I started with the 25 mg dose, AND fenugreek. It leveled back out. Just be aware. I'd read of another study where a woman had reported this too.

  20. Anonymous Anonymous | 4:07 AM |  

    http://www.drugs.com/mtm/sertraline.html

    Good site all about sertraline (Zoloft). It's the safest SSRI out there. I am trying it for depression and chronic nerve pain, and it is the only one with any margin of safety that we know thus far. I could find nothing specific while searching for months of being pregnant and now breastfeeding to find anything that did not specifically say DO NOT TAKE. There are more articles if you do a search on the site including its use in children as young as six.

  21. Blogger Kita | 6:13 AM |  

    I talked to my nurse midwife about this yesterday, since I am at a high risk of having postpartum depression again. She showed me all the literature she had on the subject and we read through it together. She, having nursed both of her boys, said that she would think the benefits far outweigh the risks in the situation. Breastfeeding helps release hormones which treat postpartum depression anyway, so it seems like if you really need to help of Zoloft, it just makes more sense to keep nursing.

  22. Blogger Kita | 6:17 AM |  

    As far as why more studies haven't been done, the animal testing that has been done has shown no adverse effects, but that is not enough to account for its effects in HUMANS.

    Now, the effects it has on our babies can't be studied unless you want them to just take a whole ton of people nursing and have them take zoloft just to see what happens. Ethical reasons are why more studies aren't being done...

  23. Blogger Rane dae | 4:17 PM |  

    For those who've expressed concern with Zoloft affecting breastmilk production:

    I have taken Z for just over a month. Before that I was on Clonapin, but as I just became pregnant, my doctor wanted to switch to Zoloft. My first son is still nursing at 18 months and I have not noticed any decrease in milk supply other than my normal fluctuations. Some days I make more, some days I don't. Could be the amount of water, or the heat, or being tired or level of nourishment that day, past few days or week. Or I could be grumpy for any combo of those things.

    If there is one thing I've learned about my body and nursing is that every day is a new day and a change for a day or two isn't worth the sweat.

    If you notice a drastic change lasting 4 or more days that doesn't seem to be affected by reducing caffeine, drinking water, eating enough of the good food and getting enough rest, then it's definitely worth a call to a lactation consultant or a doctor. La Leche League is also there to help.

    Good luck and don't panic! Keep breathing. It's going to be okay!

  24. Anonymous Anonymous | 5:22 PM |  

    I have been taking Zoloft while breastfeeding my 22 month old since he was 8 months old.
    I worry about it because there are no long term studies, he seems fine although he is always very happy and people ask me if he is always so smiley and happy. Sometimes I wonder if he is or if its the Zoloft. He is also not a very big eater when it comes to regular food. I am wondering if he is going to go through withdrawls when I wean him?!

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