Hi, everyone!

I have been working with a woman who is clinically depressed and nursing a
26 month-old who weighs 30 pounds. She nurses the child six to ten times a
day. The child also eats three full meals a day plus snacks.  The mother
has experienced several past depressions and is certain of the diagnosis.
Her psychiatrist has prescribed 50 mg. of sertraline (Zoloft) daily.  She
has been taking the meds for eight days and has noticed no behavior changes
in her child.  She is very concerned about the possible effects of the drug
on her child.  She doesn't want to wean but feels that she must take the
meds.  (She has tried unsuccessfully to combat clinical depression with
therapy in the past to and has found medication to be the only answer.)

Her psychiatrist said that he felt the dose her child would receive through
breastmilk was negligible.  He also indicated that he was not as concerned
about an older child receiving sertraline through breastmilk as he would be
about an infant.  He is very supportive of this mother continuing to
breastfeed and told her that "the nurturing relationship of breastfeeding
should not be interrupted; it was very important for her child."  (I have
to admit I almost fainted when she told me that;  I was expecting the
standard weaning advice!)

I consulted with my La Leche League professional liason and she expressed
reservations, but felt that the woman should be guided by her psychiatrist
on this.  I called the Rocky Mountain Drug Consultation Center and was told
that *no* antidepressants were recommended for nursing mothers (including
tricyclics), but if she had to take an SRI (serotonin reuptake inhibitor),
Zoloft was better than Prozac (fluoxetine).  I've consulted the PDR and
Briggs and the consensus seems to be that no one really knows how this drug
could affect a nursing child.

I would be interested to know how others have dealt with this issue.  Has
anyone worked with a mother who uses sertraline and what was the outcome?
I would appreciate any and all thoughts on this.  Thanks!

Loyann Waber, LLLL