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Serotonin Reuptake Is Normal in Nursing Infants of SSRI-Treated Mothers

There are an increasing number of studies on the effects of maternal antidepressants, particularly SSRIs, on the developing fetus or breast-feeding infant. Some studies have measured SSRI levels in infant serum; however, what is most clinically significant is the physiologic effect, if any, on the infant. These U.S. researchers examined the degree of serotonin (5-HT) transport in lactating mothers taking sertraline and in their breast-feeding babies.

Platelet levels of 5-HT in 14 nursing mother-infant pairs were studied before and after mothers began treatment with sertraline for postpartum depression. Data were also available on plasma sertraline and desmethylsertraline levels in 13 mothers and 11 infants. The duration of maternal treatment ranged from 6 to 16 weeks; dosages varied from 25 to 200 mg/day. Declines in maternal platelet levels of 5-HT ranged from 70 percent to 96 percent, whereas infant levels showed little or no change. Whereas maternal plasma levels of sertraline and desmethylsertraline were 30.7 ng/mL and 45.3 ng/mL, respectively, those of breast-feeding infants were either undetectable or at the lowest measurable level.

Comment: This study provides a physiologic explanation for the results of previous studies that demonstrated little or no effect of maternal SSRI treatment on breast-feeding infants. Given the small numbers in this study, however, further research is indicated. It is hoped that fewer mothers and families will have to choose between the significant benefits of breast-feeding and the risk for and distress of untreated depression. It is also important to remember that psychotherapy can be as effective as medication in mild-to-moderate cases of postpartum depression and can be a useful adjunct to psychopharmacologic treatment.

— NL Stotland

Published in Journal Watch Women's Health December 5, 2001

Citation(s):

Epperson N et al. Maternal sertraline treatment and serotonin transport in breast-feeding mother-infant pairs. Am J Psychiatry 2001 Oct 158 1631-1637.

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