Zoloft and Depression - 5 Month Old

[cea4915]

Hello,
I am a first time mother and I exclusively breastfeed my 5 month old son. I have a history of depression and ADHD. I was on multiple medications. I stopped taking my ADHD medicine when I found out I was pregnant. I stopped taking my antidepressants during the third trimester. Since I planned to breastfeed I did not resume taking any medications when my son was born.

I was prescribed the lowest dose of Zoloft for postpartum depression when my son was 3 months old, but have not taken it because I am concerned with the lack of long term studies on his development. I recently discovered, however, that having a depressed mother can hinder development as well. I am now concerned that I may have already hindered his development by not medicating myself. I am also concerned that I need to stop breastfeeding.

My questions are then:
1. To what extent have I already hindered my son's development by failing to treat my depression?
2. Given the lack of long term studies, wouldn't it be better to just give my son formula rather than take medication and breastfeed?
3. Would St Johns Wort be a better alternative? It seems like the studies actually show worse behaviors in infants with St Johns Wort than for Zoloft.

I just need assistance weighing the risks and benefits of all options available to me. I don't want to give up breastfeeding my son but I don't want to hurt him either. Thank you in advance for your help and discussing this with me.

[Sandra]

Cea4915, thanks for posting,

First of all I doubt you have hindered your sons development at all. We do believe that Zoloft is of minimal risk to a breastfed infant. It is rated an L1-extensive data-compatible. Only 0.4-2.2% of your dose transfers into breast milk. It is the only drug in the class that is an rated L1. We do not have long term studies but do believe the benefit of breast milk would outweigh the risk of this medication. Monitor the infant for sedation or irritability, not waking to feed/poor feeding and weight gain.

St John's Wort is rated an L2-limited data-probably compatible. We do not know how much transfers into breast milk. However, the drug-drug interactions are major. SJW stimulates drug metabolism in the liver, and has been reported to reduce plasma levels and effectiveness of many drugs by 50% or more. Do not use while taking other important drugs (birth control, anticonvulsant, antihypertensives, etc). Monitor the infant for insomnia, irritability, dry mouth, vomiting, diarrhea or constipation.Patients should always inform their physicians of their use of St. John's Wort. Please be aware that many products produced and sold in the USA and Canada may be of poor quality and contain little or no SJW. Users should only purchase standardized or assayed products from reputable sources.

We believe the Zoloft would be the better choice because of the extensive data, but of coarse the decision is yours. I hope this helps. If you have any other questions please call the InfantRisk Center at 806-352-2519. Thanks,

Sandra Lovato R.N.
InfantRisk Center