Abstract
Successfully mastering the art of breast-feeding is one of the greatest builders of self-esteem a mother can have, and if she is suffering from postnatal depression, it is often the only thing she feels she can do well. To be told that she needs medication to help her condition is often a worrying experience for her.
Until recently the choice of antidepressants for breast-feeding mothers in the Hunter appeared to be the tricyclic dothiapin, however, in the last 18 months the newer SSRIs have been used.
Research on the excretion of sertraline in the breast milk and the blood-level in the baby shows the sertraline levels are very low [1–3]. However, I have not found data relating to the effects of sertraline on the mother's milk supply.
For the past 5 years, I worked at John Hunter Hospital Newcastle as a midwife on a multidisciplinary team with social workers and a psychiatrist, supporting women suffering from postnatal depression. During a 3-month period each of the 6 patients I cared for who began treatment with sertraline experienced a reduction in their milk supply upon commencing the medication. This effect was overcome by increasing both oral fluids and the frequency of feeding, with a return to normal supply after 2–3 days. All cases occurred at 3–4 months post-partum after lactation had been established. One patient had been on sertraline from 6 months gestation and had established breast-feeding successfully. At 4 months post-partum she was without her medication for 1 week. During this period she experienced an increase in breast milk supply followed by a reduction when she re-commenced the sertraline.
There is no dispute about the benefits of breastfeeding to both mother and baby, especially if bonding problems are experienced, nor of the benefits of sertraline as an antidepressant. We, as primary health professionals, are in a unique position to be able to reassure mothers that a reduction in breast milk supply appears to be temporary and can be restored by extra fluids and demand feeding.