Interesting that the physician would pick the two antidepressants which
are probably the safest to use during lactation.  Dr. Hale covers this
well.  There is also a letter in the New England Journal of April 17,
1997, describing an experiment which shows that platelet reuptake of
serotonin (the same system which is inhibited in the brain, according to
the authors), is inhibited in mothers taking sertraline, but not their
infants.  This is good evidence that not only is sertraline not absorbed
by the baby, but also that there is no pharmacologic effect (in case the
other study showing no blood levels was somehow wrong).

The mother should let the physician know about this.  She should point
out to him/her that the risks of formula feeding are not negligible and
that she has no intention of stopping, as is her right.  The physician
can advise, but not command.  If the mother needs this medication, there
is nothing the physician can do except give his advice and then
prescribe it.

Jack Newman, MD, FRCPC