Is Zoloft (sertraline) safe while breastfeeding?

What does the evidence say about Zoloft while breastfeeding?

1. Sertraline and paroxetine are described as among the safest SSRIs during breastfeeding, with lower plasma levels detected in nursing infants compared with some other antidepressants like fluoxetine. 1
2. Sertraline gets into breast milk in small amounts, and most babies exposed to it through breast milk don't have side effects, though caregivers should contact their child's provider about unusual irritability or drowsiness. 2
3. Most authoritative reviewers consider sertraline a preferred antidepressant during breastfeeding, an exclusively breastfed infant is estimated to receive roughly 0.5% to 1.2% of the mother's weight-adjusted dose, and no adverse effects on development were found in infants followed up to age 5. 3
4. In a direct comparison of three SSRIs, sertraline had an estimated relative infant dose of about 1%, well under the 10% level commonly used as a safety marker, and it was undetectable in blood tests for all 15 breastfed infants studied. 4
5. Leaving postpartum depression untreated carries its own risks, including a higher chance of the illness becoming long-lasting, harder to manage, or more severe, which is part of why continuing an effective antidepressant like sertraline during breastfeeding is often recommended over stopping. 1

How Zoloft changes by nursing stage

• Early weeks. In the first weeks after birth, sertraline is one of the more studied antidepressants in nursing mothers, which is part of why it's often chosen if you're starting medication fresh for postpartum depression or anxiety, or continuing a dose from pregnancy.
• Established nursing. Once breastfeeding is established, only small amounts of sertraline typically reach a baby's bloodstream, and most nursing infants show no side effects. Watch for unusual irritability, poor feeding, or excess drowsiness, and mention any of those to your child's provider.
• Weaning. For a baby born preterm or slower to clear medications, a bit of extra observation is reasonable since the drug can build up more easily in that situation. Beyond that, longer-term use while nursing hasn't been linked to developmental problems in children followed up to about age 5.