Both fluoxetine (Prozac) and fluvoxamine (Luvox) can be justified during
breastfeeding.  The risks to the baby of the small amount of medication
is less, in my opinion, than not breastfeeding.  This is even more an
issue where psychological problems in the mother could possibly
interfere with the mother child relationship.

However, why not use medication which is, at least in theory, much less
likely to get into the milk?  Both sertraline (Zoloft) and paroxetine
(Paxil) fit the bill.

The baby's levels do not have to be tested.  What for?  Even if it were
a useful test, once might be enough, *once* a steady state occurred.  If
the mother is on these medications during pregnancy, the blood levels
would likely be similar to mother's for severals days after birth.  By
the way, is the physician not concerned about the mother being on these
drugs during pregnancy?  Only during breastfeeding?

Jack Newman, MD, FRCPC