Antidepressants of choice during Lactation.

Q: The postnatal period represents a critical phase for mothers with history of major depression. Which of the following antidepressant have better neonatal safety profile and is preferred over other antidepressants during breastfeeding period?











  • Sertraline

  • Paroxetine

  • Nortriptyline



  • TOXNET Toxicology Date Network.
  • Arch Womens Ment Health. 2015 Apr;18(2):139-46.
  • Other studies are discussed below.



  • Preferred antidepressant during breastfeeding. 

  • Levels in breastmilk: LOW. 

  • Levels in Infant: Minimal/no level detected. Note that desmethylsertraline (active metabolite) is often weakly detected in low levels. 



  • Preferred antidepressant during breastfeeding. 

  • Levels in breastmilk: LOW.

  • Levels in Infant: Minimal/no level detected.

  • NOTE: Mothers taking paroxetine during third trimester have reported occasional side effects. 



The available data on antidepressant levels in nursing infants were analyzed in order to calculate average infant drug levels and determine what factors influence plasma drug levels in breast-feeding infants of mothers treated with antidepressants.

  • Nortriptyline, paroxetine, and sertraline may be preferred choices in breast-feeding women.

  • Minimizing the maternal dose may be helpful with citalopram.

  • This data do not support monitoring breast milk levels in individual patients. 


Source: Am J Psychiatry. 2004 Jun;161(6):1066-78.



  • When antidepressant treatment is indicated in women with postpartum depression, they should not be advised to discontinue breastfeeding. 

  • Paroxetine and sertraline are most likely suitable first-line agents. 

  • The highest infant plasma levels have been reported for fluoxetine, citalopram and venlafaxine.  

    Note that if mother has been treated with one of these drugs during pregnancy, breast-feeding could also be allowed during continued treatment with these drugs in the postpartum period. However, an individual risk-benefit assessment should always be performed.

  • Suspected adverse effects have been reported in a few infants, particularly for fluoxetine and citalopram.

  • Duloxetine and bupropion have undetectable levels in infant.

  • Escitalopram, reboxetine and mirtazapine detected at extremely low concentrations in infant plasma.


Source: Curr Womens Health Rev. 2011 Feb; 7(1): 28–34.



  • Sertraline and paroxetine show a better neonatal safety profile during breastfeeding as compared with other SRIs.


Source: Hum Psychopharmacol. 2015 Jan;30(1):4-20.

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Dr. Harvinder Singh, M.D. (Admin)

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