It's getting depressing how often this subject comes up.

There is no definite answer on antidepressants.  Those of us that
believe that breastfeeding is important and that the there are
definite risks to artificial feeding believe that the mother can take
antidepressants and continue to breastfeed.  As many physicians
believe that breastfeeding and bottle feeding are about the same, or
even that artificial feeding is *better*, they will say the mother
should not breastfeed.

I would say that sertraline (Zoloft), for theoretical reasons (high
protein binding and others) would be a better choice than fluoxetine
(Prozac) although we have had many mothers breastfeed with fluoxetine
without any discernable effect on the baby.  A recent assay done in a
nursing mother at our mother risk clinic in Toronto had the baby with
undetectable levels of sertraline in his blood.  This does not mean
zero, but just below the detectable level of the lab.  But it does
mean very little.

Thus, given the uncertainties of the long term effects of the
antidepressants on the baby, what should we advise the mother?  We
should tell her that we do not know the long term possible risks, but
we do know there are definite risks with artificial feeding, some of
them serious.  It is true that most babies fed artificially are do not
get serious side effects, but then we do not know who will get the
side effects, and there are quite likely other long term side effects
we do not know about, given the very great differences between
breastmilk and artificial baby milk.  AND THE MOTHER, ONCE SHE HAS AS
MUCH INFORMATION AS SHE NEEDS, SHOULD THEN MAKE HER CHOICE AND ALL OF
US, INCLUDING THE PHYSICIAN, SHOULD SUPPORT HER.

Jack Newman, MD, FRCPC