Question

You just delivered a 32-year-old patient at term while covering for your partner. She had an uneventful pregnancy, followed by a normal spontaneous vaginal delivery. She is taking Sertraline (Zoloft), a selective serotonin uptake inhibitor (SSRI) as an antidepressant and wants to breastfeed. What is the next best step in management of this patient at this time?

1) Decrease her SSRI dose by 50
2) Consult psychiatry about changing medications and discard the expressed milk in the meantime
3) Discontinue the medications so she can breastfeed
4) Increase her SSRI dose, since these drugs are not concentrated in the breast milk and she is at great risk for postpartum depression
5) Continue the medications, since there is negligible risk for the newborn

Answer 1

The patient should continue taking Sertraline as this SSRI's presence in breast milk is minimal and generally considered safe during breastfeeding. It is vital to monitor the infant for any side effects and consult a psychiatrist if necessary.

Step-by-step explanation:

The patient in question is currently taking Sertraline (Zoloft), which is a type of Selective Serotonin Reuptake Inhibitor (SSRI). It is well-documented that SSRIs can pass into breast milk in small amounts. However, the evidence to date indicates that sertraline is generally considered safe for use during breastfeeding due to very low levels in breast milk. The benefits of continued treatment for the mother must be weighed against any potential risks to the nursing infant. The recommendation, in this case, would be option 5) Continue the medications, since there is a negligible risk for the newborn. This allows the mother to maintain her mental health, which is crucial for both her well-being and her ability to care for her newborn child. It is essential to monitor the infant for any signs of side effects and to consult a psychiatrist if any concerns arise.