a University of Siena , Department of Molecular and Developmental Medicine (AC, GDM, SS, BBC, SB, AG, AF).
b University of Torino , Department of Neuroscience (GM , GR ).
Expert Opin Drug Saf. 2018 Jul;17(7):719-725. doi: 10.1080/14740338.2018.1491546. Epub 2018 Jul 5.
The World Health Organization recommends newborns to be breastfed but this may be challenging if the mother needs to be treated for depression, since strong evidence to inform treatment choice is missing.
We provide a critical review of the literature to guide clinicians who are considering sertraline for the management of depression during postpartum.
Sertraline is one of the safest antidepressants during breastfeeding. In most cases, women already taking sertraline should be advised to breastfeed and continue the medication. We recommend to begin with low doses and to slowly increase the dose up, with careful monitoring of the newborn for adverse effects (irritability, poor feeding, or uneasy sleep, especially if the child was born premature or had low weight at birth). The target dose should be the lowest effective. When feasible, child exposure to the medication may be reduced by avoiding breastfeeding at the time when the antidepressant milk concentration is at its peak. A decision to switch to sertraline from ongoing and effective treatment should be taken only after a scrupulous evaluation of the potential risks and benefits of switching versus continuing the ongoing medication while monitoring the infant carefully.
世界卫生组织建议对新生儿进行母乳喂养，但如果母亲需要治疗抑郁症，这可能具有挑战性，因为缺乏明确的治疗选择依据。
我们对文献进行了批判性评估，以指导考虑使用舍曲林治疗产后抑郁症的临床医生。
舍曲林是哺乳期最安全的抗抑郁药之一。在大多数情况下，应建议正在服用舍曲林的女性进行母乳喂养并继续服药。我们建议从低剂量开始，缓慢增加剂量，并仔细监测新生儿是否有不良反应（烦躁、喂养不良或睡眠不安，尤其是如果孩子早产或出生体重低）。目标剂量应为最低有效剂量。在可行的情况下，通过避免在抗抑郁药乳汁浓度达到峰值时进行母乳喂养，可减少儿童暴露于药物的风险。只有在仔细评估了转换药物的潜在风险和益处，并在仔细监测婴儿的情况下继续使用正在进行的药物，才应决定从正在进行且有效的治疗中改用舍曲林。
