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One of the most vexing problems in treating postpartum depression is uncertainty about the delivery of antidepressants to infants through breast milk. The SSRIs are effective, but there are few studies on their use during lactation. These authors reviewed the existing literature on 18 cases and studied an additional nine mother-nursling pairs.
Mothers had DSM-IV-confirmed depression and were receiving 50 to 200 mg/day of sertraline. Infants were full-term, healthy, fully breast-fed, and 4 to 22 weeks old. Seven infants had undetectable (<2 ng/ml) sertraline levels, and an eighth had a very low level (3 ng/ml). One infant's serum level was half that of the mother's. Since this finding was entirely inconsistent with others, the authors opined …