Sertraline is the generic name of Zoloft, not a woman's name.  I got a
call yesterday from a woman who apparently needs an antidepressant,
fluoxetine (Prosac) was the one which was recommended for her.  She is
about 350 km from Toronto (200 miles) and her psychiatrist was
refusing to prescribe it unless the mother weaned her baby.  Obviously
she did not want to, otherwise she would not have contacted me.

It came down to this.  Because the Compendium of Pharmaceutical
Specialities (CPS-our equivalent of the American Physicians' Desk
Reference) said fluoxetine was contraindicated during lactation, she
(the psychiatrist) did not want to risk prescribing it.  It also came
out that the psychiatrist not uncommonly prescribed fluoxetine during
pregnancy, even though the CPS also says it is contraindicated during
pregnancy.  Of course, the CPS (which is basically a compendium of
drug information from the pharmaceutical companies themselves) is
protecting the companies, not mothers and babies.  This is often the
unspoken reason for which physicians are reluctant to prescribe
medication to nursing mothers.  It is medical-legal question, not
concern for the baby, though obviously there are exceptions and
concern for the baby may play a part.  The fact that the psychiatrist
was ready to risk prescribing it during pregnancy but not lactation,
adds another wrinkle.  Probably (just a guess) the psychiatrist did
not nurse her own children, if she has any, and thus is carrying her
own emotional baggage along which influences her approach to nursing
mothers.  There was no point in the mother asking her family doctor
for the prescription because he refuses to prescribe even plain ol'
penicillin for a nursing mother.  AAARGH!

So did the mother get Zoloft?  Yes, she did, because the psychiatrist
was willing to go along if *someone else* prescribed it.  So who did?
I did, without knowing or ever meeting the mother, or whether she
really needs the drug.  The psychiatrist will follow her.  Am I sorry?
No, because I believe in the importance of breastfeeding, of the
mother having a choice, and if we believe in the importance of
breastfeeding, we need to take risks.  No risk, no gain.

The preceding was a rant.

Jack Newman, MD, FRCPC