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Tuesday, December 20, 2005With 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.
Labels: Stats and Studies