To answer your question:

There would be no detrimental effect on mother if she divided the dose 
in two.  The only disadvantage is that she
is more likely to forget a dose. When I prescribe zoloft to mothers I 
start at 25 or 50 mg and gradually increase in 25-50 mg increments
until she is stable.  Maybe starting low and monitoring her infant 
would have two benefits. Mom is less lkely to have side effects
and she can watch her infant and when she sees her infant not having 
any response it will build her confidence that it won't hurt her baby.


A couple of other thoughts you are welcome to use to help counsel this 
mom:

Did you mention to her the study that showed there was no response in 
blood seritonin receptors of infants whose mothers took
100mg?  IF there is no reaction in the blood there is no way there is 
any reaction in the brain which is harder for meds to penetrate.

Haivng said that, the half life of Zoloft is extremely long and the 
peak is 7-8.  If the infant sleeps over 8 hours at night she could dose 
at bedtime and
thus avoid the peak.  Twice daily dosing would lower the peak but there 
would be two peaks a day instead of one.

The theoretical dose is 21.45 ug/kg/day--does she realize there is 
probably more cyanide, lead, and medications like prozac in the water 
she drinks and will likely use to make the formula
than in her milk?

She could have her dr. measure infant blood levels of zoloft.

Depending on how severe her depression, she could try increasing her 
exercise and psychotherapy instead of meds.

I work at  Children's hospital and in our NICU even the littlest and 
sickest infants would be given maternal milk from mothers who take not 
only zoloft but many more
problematic meds. In fact, our informal policy is if its an L3 or less 
then we give it without consulting the MD if its an L4 we discuss it.  
L5 aren't given.


Bottom-line health-wise infants of depressed mothers are not as healthy 
as infants of non-depressed mothers , formula fed infants are not as 
healthy as breastfed infants and there is no
evidence to my knowledge of any direct side effects in breastfed 
infants of mothers taking zoloft.  So which caries a higher risk 
formula feeding with maternal anti-depressant or breastfeeding and 
using an antidepressant?
Well, given that there is no evidence of any direct harm from zoloft 
and that there is a multitude of risks for using formula it is logical 
to conclude that breastfeeding and using zoloft is a safer choice.

Hope that helps, Chris




Christine M. Betzold NP CLC MSN



Date:    Wed, 15 Apr 2009 08:43:15 EDT
From:    [log in to unmask]
Subject: benefit to dosing sertraline
MIME-Version: 1.0
Content-Type: text/plain; charset="UTF-8"
Content-Transfer-Encoding: quoted-printable

Tom Hale is currently not available on his forum, so asking here:  
would=

divided dose of sertraline (Zoloft) be beneficial in reducing  
immediate=

effects on infant?  I realize a once daily dose of say 100 mg  might be 
us=
ual way
to dose, but mom I'm working with has asked if it would help  to take 
her=

Zoloft twice a day as far as possible side effects in her 6.5 mos  
infant.=
 (I
also realize side effects are rare and have shared all this info but  
mom=

is anxious about using medication in the first place and considering
weaning.  Also, would dividing dose have any effect on the efficacy for 
=
 mom?

Barbara Latterner, BSN, RN, IBCLC
**************Great deals on Dell=E2=80=99s most popular laptops 
=E2=80=93=
 Starting at
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(http://pr.atwola.com/promoclk/100126575x1220631252x1201390195/aol?redir=

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