BREAST-FEEDING AND SERTRALINE - A 24-HOUR ANALYSIS

Background: Few reports exist on the levels of antidepressants in brea st milk or on observed behavioral effects, if any, of neonates who are breast-fed. Thus, a dilemma exists for women who would like to breast -feed but require psychotropic medications. Method: Analysis of sertra line levels was performed on eight samples of breast milk obtained ove r a 24-hour period, after 3 weeks of breastfeeding, from a lactating p atient taking sertraline and nortriptyline. During this same 24-hour p eriod, two serum samples each were taken from mother and child for ana lysis of sertraline and nortriptyline levels. After 7 weeks of exclusi ve breastfeeding, an additional serum sample was obtained from mother and child for analysis of sertraline levels. Drug metabolites were not measured. Results: Breast milk levels of sertraline were lowest 1 hou r before the ingestion of sertraline and highest 5 to 9 hours after in gestion of the drug. The infant's serum sertraline and nortriptyline l evels were nondetectable. Conclusion: These data indicate that sertral ine levels in breast milk vary substantially over 24 hours and appear to be lowest within the 2 hours before and 1 hour after ingestion of t he medication, with the peak probably occurring between Hours 1 and 9 postingestion. However, the absence of detectable serum sertraline and nortriptyline levels in the infant suggests that if either medication is present in infant serum, its concentration would be extremely low. No abnormal occurrences have been noted in the development of the inf ant. It would be important in future studies to measure metabolites in addition to medication levels since the former have been associated w ith untoward events in an infant.