Maternal sertraline treatment and serotonin transport in breast-feeding mother-infant pairs

Am J Psychiatry. 2001 Oct;158(10):1631-7. doi: 10.1176/appi.ajp.158.10.1631.

Abstract

Objective: Pharmacological treatment of postpartum depression is frequently complicated by the mother's desire to breast-feed. Although breast milk levels of several selective serotonin reuptake inhibitors (SSRIs) have been reported to be relatively low, a critical question is whether SSRI exposure during nursing results in clinically significant blockade of serotonin (5-HT) reuptake in infants. This study determined the degree of transporter blockade in infants exposed to sertraline through maternal breast milk.

Method: The extent of maternal and infant transporter blockade was assessed by measurement of platelet levels of 5-HT in 14 breast-feeding mother-infant pairs before and after 6-16 weeks of maternal treatment with sertraline for major depression with postpartum onset. Plasma sertraline and desmethylsertraline levels were obtained in 13 of these mothers and 11 of their infants.

Results: Marked declines in platelet 5-HT levels of 70%-96% were observed in mothers after sertraline treatment, 25-200 mg/day. In contrast, infants showed little or no change in platelet 5-HT levels after exposure through breast-feeding. Mean levels of maternal plasma sertraline and its major metabolite, desmethylsertraline, were 30.7 ng/ml and 45.3 ng/ml, respectively. Drug and drug metabolite concentrations in the infants were at or below the lower limit of quantitation.

Conclusions: The data indicate that while mothers receiving clinical doses of sertraline experience substantial blockade of the platelet 5-HT transporter, platelet 5-HT uptake in nursing infants of treated mothers is unaltered. The observations suggest that mothers taking sertraline can breast-feed without appreciably affecting peripheral or central 5-HT transport in their infants.

Publication types

  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Blood Platelets / chemistry
  • Blood Platelets / drug effects
  • Blood Platelets / metabolism
  • Breast Feeding*
  • Carrier Proteins / drug effects
  • Carrier Proteins / metabolism
  • Depression, Postpartum / blood
  • Depression, Postpartum / drug therapy*
  • Depression, Postpartum / metabolism
  • Female
  • Humans
  • Infant, Newborn / blood*
  • Membrane Glycoproteins / drug effects
  • Membrane Glycoproteins / metabolism
  • Membrane Transport Proteins*
  • Milk, Human / chemistry
  • Milk, Human / drug effects
  • Milk, Human / metabolism*
  • Nerve Tissue Proteins*
  • Serotonin / blood
  • Serotonin / metabolism*
  • Serotonin Plasma Membrane Transport Proteins
  • Serotonin Uptake Inhibitors / analysis
  • Serotonin Uptake Inhibitors / pharmacokinetics
  • Serotonin Uptake Inhibitors / therapeutic use*
  • Sertraline / analogs & derivatives
  • Sertraline / analysis
  • Sertraline / blood
  • Sertraline / pharmacokinetics
  • Sertraline / therapeutic use*

Substances

  • Carrier Proteins
  • Membrane Glycoproteins
  • Membrane Transport Proteins
  • Nerve Tissue Proteins
  • SLC6A4 protein, human
  • Serotonin Plasma Membrane Transport Proteins
  • Serotonin Uptake Inhibitors
  • Serotonin
  • desmethylsertraline
  • Sertraline