Altshuler L L, Burt V K, McMullen M, Hendrick V
UCLA Neuropsychiatric, USA.
J Clin Psychiatry. 1995 Jun;56(6):243-5.
Few reports exist on the levels of antidepressants in breast milk or on observed behavioral effects, if any, of neonates who are breast-fed. Thus, a dilemma exists for women who would like to breast-feed but require psychotropic medications.
Analysis of sertraline levels was performed on eight samples of breast milk obtained over a 24-hour period, after 3 weeks of breastfeeding, from a lactating patient taking sertraline and nortriptyline. During this same 24-hour period, two serum samples each were taken from mother and child for analysis of sertraline and nortriptyline levels. After 7 weeks of exclusive breastfeeding, an additional serum sample was obtained from mother and child for analysis of sertraline levels. Drug metabolites were not measured.
Breast milk levels of sertraline were lowest 1 hour before the ingestion of sertraline and highest 5 to 9 hours after ingestion of the drug. The infant's serum sertraline and nortriptyline levels were nondetectable.
These data indicate that sertraline levels in breast milk vary substantially over 24 hours and appear to be lowest within the 2 hours before and 1 hour after ingestion of the medication, with the peak probably occurring between Hours 1 and 9 postingestion. However, the absence of detectable serum sertraline and nortriptyline levels in the infant suggests that if either medication is present in infant serum, its concentration would be extremely low. No abnormal occurrences have been noted in the development of the infant. It would be important in future studies to measure metabolites in addition to medication levels since the former have been associated with untoward events in an infant.
关于母乳中抗抑郁药的水平以及母乳喂养的新生儿是否出现行为影响（若有）的报道很少。因此，对于想要母乳喂养但需要服用精神药物的女性来说，存在两难困境。
对一名服用舍曲林和去甲替林的哺乳期患者在母乳喂养3周后24小时内采集的8份母乳样本进行舍曲林水平分析。在同一24小时内，分别从母婴身上采集两份血清样本，用于分析舍曲林和去甲替林水平。在纯母乳喂养7周后，从母婴身上再采集一份血清样本用于分析舍曲林水平。未测量药物代谢产物。
舍曲林的母乳水平在服用舍曲林前1小时最低，在服药后5至9小时最高。婴儿血清中的舍曲林和去甲替林水平未检测到。
这些数据表明，母乳中的舍曲林水平在24小时内有很大变化，且在服药前2小时和服药后1小时内似乎最低，峰值可能出现在服药后1至9小时之间。然而，婴儿血清中未检测到舍曲林和去甲替林水平，这表明如果婴儿血清中存在任何一种药物，其浓度会极低。婴儿发育过程中未发现异常情况。由于药物代谢产物与婴儿不良事件有关，因此在未来研究中除测量药物水平外还测量代谢产物很重要。
