Does taking Zoloft and breastfeeding affect your baby?

The postpartum period is challenging for all new moms, but no matter what your well-meaning friend or mother-in-law tells you, feeling extremely anxious or depressed after giving birth isn’t “normal.” Fluctuating hormones, dramatic life changes, intense stress, and debilitating sleep deprivation can all converge in those early weeks to create a perfect mental health storm, leaving some women with more than just the baby blues. 

Affecting about 10% to 15% of new moms, postpartum depression (PPD) and postpartum anxiety (PPA) are real mental health conditions that require intervention, support, and treatment.

If you or someone you know is struggling after giving birth, therapy can help—but many of these moms need medication, too. For some healthcare providers, Zoloft (sertraline) is a strong candidate for treating breastfeeding women with depression or anxiety. This may be partly because Zoloft is a relatively low-risk option for treating these conditions during pregnancy (under a provider’s supervision, of course).

But is Zoloft safe during breastfeeding? How much can you take? And are there other ways to treat PPD and PPA while nursing your baby? Here’s what you need to know.

Is Zoloft safe to take while breastfeeding? 

For the most part, yes: Zoloft is a safe antidepressant to take while breastfeeding, according to G. Thomas Ruiz, MD, OB-GYN lead at MemorialCare Orange Coast Medical Center.

“If you have to medicate someone with postpartum depression or anxiety [who is also nursing], most doctors will go to Zoloft first,” he says. “If you have to use an antidepressant in that case, it’s the safest one.”

Of course, that safety recommendation comes with a caveat—as does any other recommendation about using medication while pregnant or nursing. Because pregnant and nursing mothers are often excluded from clinical trials, there isn’t usually a wide body of evidence pointing clearly to a drug’s safety or lack thereof. This means there’s always a chance that a drug could affect your baby.

“There is a [scarcity] of data on the neurodevelopmental effects on the infant from breastfeeding while on Zoloft,” says Kecia Gaither, MD, a double board-certified OB-GYN and maternal fetal medicine physician and director of perinatal services at NYC Health + Hospitals/Lincoln.

Basically, there isn’t any evidence of harm…but there also isn’t any studies proving that the drug is definitely safe, either.

That doesn’t mean you should panic if your doctor suggests prescribing you Zoloft to manage PPD or PPA while breastfeeding. Many of the most common concerns about how Zoloft can affect your baby or your milk supply are unfounded.

• There is no evidence that a mother’s use of Zoloft during breastfeeding causes developmental delays. The majority of drugs aren’t contraindicated for use during breastfeeding, according to the American Academy of Pediatrics (AAP).
• There is no evidence of a relationship between Zoloft and autism in nursing babies. A few studies have suggested a possible relationship between Zoloft taken during pregnancy and autism, but many other studies have debunked that connection—and none of these studies looked at breastfeeding.
• Generally speaking, there isn’t reason to suspect that Zoloft can affect a mother’s milk supply. Dr. Ruiz says that Zoloft works along your body’s serotonin system, which is a totally different system than the hormonal one your body’s breastfeeding system works along (i.e., the system that regulates your prolactin levels).

A 2019 review of sertraline reported in LactMed found few adverse events tied to the use of Zoloft during breastfeeding; in large part, any adverse events resolved themselves or could have been due to other coexisting factors.

How much Zoloft is safe to take while breastfeeding? 

One of the concerns many new moms have about their Zoloft dosage is about how much or how little of the drug is passed through their breast milk to the baby. However, there’s nothing to suggest that the risks of taking Zoloft increase or decrease depending on your dosage; if your doctor determines that Zoloft is a safe drug for you to use during breastfeeding, you should work together to find the dosage that helps most with your symptoms of PPD or PPA.

“A small amount of Zoloft is excreted in breast milk, [but it’s negligible] and not at a level thought to be harmful to the baby or that could create serotonin side effects,” Dr. Ruiz says.

In fact, a 2016 meta-analysis published in the Archives of Women’s Mental Health suggests that Zoloft is the “antidepressant of choice” for nursing moms because of how little sertraline is passed on to the baby via breast milk; in several studies, no amount of the drug was detected in infants whose mothers used it during breastfeeding. 

What about other antidepressants…are they safe to use during breastfeeding? 

According to Dr. Ruiz, any of the common SSRIs (selective serotonin reuptake inhibitors) used as antidepressants can be taken during breastfeeding—but Zoloft has the best side effect profile, making it especially breastfeeding-friendly. Other SSRIs have been observed to cause irritability, colic, nausea, and decreased sleep. 

At the same time, there are no overarching recommendations about the safety of SSRIs for breastfeeding women.

“Assigning specific antidepressants in a woman with depression should be done on a case by case basis, under the direction of a psychiatrist, taking into consideration the benefits of therapy [and other treatments],” says Dr. Gaither. “There is no set-in-stone methodology for which treatment works for whom.” 

In other words, talk to your healthcare providers; they are in the best position to assess your risk versus benefit profile for any drug you may need during breastfeeding.

Alternative ways to cope with postpartum depression and anxiety

So how do you know if your PPD or PPA warrants medication use? Thankfully, you don’t have to know at all—there are professionals who can help you determine the best course of treatment.

If you or one of your loved ones is concerned about your mental health after having a baby, there are a few basic steps to follow:

• Talk to your OB-GYN, primary care provider, or even your baby’s pediatrician. All of these healthcare providers are trained to screen postpartum women for signs and symptoms of depression and anxiety.
• Schedule an appointment for mental health counseling. Dr. Ruiz says that cognitive behavioral therapy (CBT) is the most effective therapy for PPD and PPA and should be the first line of defense in your treatment.
• Shore up more support where you can. “As long as there are no concerns about mom being a danger to herself or her baby, the next step is to assess the support structure,” says Dr. Ruiz, who adds that making sure Mom has someone around frequently to assist her with household and newborn care tasks, as well as to check in on her mental health, is critical.
• Pause to evaluate progress. Dr. Ruiz says that sometimes, when CBT is going especially well, SSRI use can be avoided. If you still feel you need more help, however, don’t hesitate to communicate that.
• If necessary, work with a psychiatrist to adjust a prescription for Zoloft or another SSRI. Finding the right dose requires some trial and error; psychiatrists are experienced in helping their patients begin new prescription drugs, manage any side effects, and increase dosages when needed.
• Maintain a regular therapy schedule. Zoloft alone won’t give you the same results as Zoloft combined with CBT, plus most SSRIs take several weeks to fully “work” (meaning you’ll have a period of time when therapy is still your primary treatment).

If you or someone you know is experiencing suicidal thoughts, help is available. Call the National Suicide Prevention Hotline at 800-273-8255, where professionals are standing by 24/7 to talk and provide emotional support.