Zoloft, Wellbutrin, and More: Are Antidepressants Safe for Breastfeeding?
Key takeaways:
All antidepressants are passed into breast milk. But for most people, the benefits of breastfeeding, and of getting treated for mental health conditions, outweigh the small risks of taking an antidepressant.
Zoloft (sertraline) is one of the safest antidepressants to take while breastfeeding. It’s a selective serotonin reuptake inhibitor.
If medications like Zoloft aren’t an option, your healthcare provider may recommend Pamelor (nortriptyline) or Tofranil (imipramine). These tricyclic antidepressants are also preferred options while breastfeeding.
Your healthcare provider can help you figure out the best medication to take while breastfeeding. Your best option usually depends on your health background, your symptoms, and what has worked well for you in the past.
Pregnancy can be a beautiful journey for many women. Your body goes through several changes, and it continues to change after giving birth.
Among these changes, it’s common to experience temporary feelings of sadness and worry. These are often called the “baby blues.” But when these feelings last for 2 weeks or longer, it may be a sign of postpartum depression (PPD).
It’s common to experience PPD. And it’s nothing to be ashamed about, either. Still, treating PPD is important for you and your new baby. PPD is treatable with therapy, medication, and/or support from your family and friends.
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While antidepressants are commonly used to treat PPD, some antidepressants are safer than others when it comes to breastfeeding. Here, we’ll discuss the safest antidepressant medications for you and your baby.
Which antidepressants are safe to take while breastfeeding?
Since there are many antidepressants available, you may be wondering: which one would be the best for me and my baby? To answer this question, it is important to talk with your healthcare provider and discuss the following topics:
Are your PPD symptoms mild, moderate, or severe?
What are the risks of not treating PPD?
What are the risks of taking an antidepressant while breastfeeding?
Have you had success with a certain antidepressant in the past?
Did you take an antidepressant during your pregnancy? If so, did you have success with a certain one?
How strong is your desire to breastfeed your baby?
What are the disadvantages to not breastfeed your baby?
With this conversation in mind, your healthcare provider may opt for a selective serotonin reuptake inhibitor (SSRI). SSRIs are first-choice treatment options for PPD while breastfeeding. Two of the safest SSRIs while breastfeeding are Zoloft (sertraline) and Paxil (paroxetine).
Zoloft and Paxil aren’t the only choices. Tricyclic antidepressants (TCAs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are also options.
TCAs, such as Pamelor (nortriptyline) and Tofranil (imipramine), are considered to be safer medications to take while breastfeeding. Minimal medication is passed to infants, and there aren’t any reports of short-term side effects.
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SNRIs, such as Effexor (venlafaxine) and Cymbalta (duloxetine), are usually only recommended if SSRIs aren’t helping or you’re already taking a SNRI that manages your symptoms. SNRIs don’t have as much supporting data in this population.
Next, we’ll discuss specifics about certain antidepressants for PPD.
Zoloft and breastfeeding
Zoloft is a SSRI that’s commonly used to treat depression, anxiety, and more. It raises the levels of serotonin, a chemical messenger in the brain and body that is known to regulate mood and anxiety.
Is it safe to take Zoloft while breastfeeding?
Yes, probably. Zoloft is a preferred medication for PPD while breastfeeding. If you want or need medication to address your symptoms, your healthcare provider may decide to prescribe Zoloft. Other SSRIs that are generally safe for most people to take while breastfeeding are Paxil and Luvox (fluvoxamine).
Is it possible for Zoloft to be transmitted through breast milk?
Yes, but not as much as other antidepressants. Studies have found that negligible amounts of Zoloft are excreted in breast milk. There haven’t been any clear reports of sertraline causing side effects or growth abnormalities in breastfed infants.
Pamelor and breastfeeding
Pamelor is a TCA that’s approved to treat depression. It’s often taken 3 or 4 times daily, and it works by regulating several brain chemicals that affect mood — serotonin, norepinephrine, acetylcholine, and more.
Is it safe to take Pamelor while breastfeeding?
Yes, probably. Pamelor is another preferred antidepressant to consider while breastfeeding. A limited amount of Pamelor enters breast milk, and immediate side effects haven’t been reported in infants. There haven’t been any reports of growth or development issues, either.
Wellbutrin and breastfeeding
Wellbutrin (bupropion) is an antidepressant used for depression and seasonal affective disorder. It’s thought to regulate the levels of brain chemicals called norepinephrine and dopamine.
Is it safe to take Wellbutrin while breastfeeding?
We don’t know for sure. Wellbutrin hasn’t been studied as much as other medications, like SSRIs. Some studies have found that infants can be exposed to small amounts of Wellbutrin via breast milk. However, potential side effects — if any — need to be studied more.
Since very little data exists on Wellbutrin’s safety while breastfeeding, it’s generally not a first-choice treatment option. This is a precautionary measure. It’s important to speak with your healthcare provider to discuss benefits and risks of taking Wellbutrin while breastfeeding. They can tell you more about what to expect.
Remeron and breastfeeding
Remeron (mirtazapine) is an atypical antidepressant used to treat depression in adults. It improves levels of serotonin and norepinephrine in the brain. The most common side effect of Remeron is sleepiness, so this medication should be taken at night.
Is it safe to take Remeron while breastfeeding?
Like Wellbutrin, we don’t know for sure. Very small amounts of Remeron can get into breast milk, but it hasn’t been connected to side effects in infants.
More data is needed on the safety of Remeron while breastfeeding. It’s still a possible treatment option, but it’s not a first-choice medication.
Which antidepressants should I avoid while nursing?
Prozac (fluoxetine), Celexa (citalopram), and Effexor heed the most caution. They pass through breast milk in higher amounts than other antidepressants. This has the potential to lead to short-term side effects.
For instance, limited reports have found that Prozac can contribute to crying, irritability, and watery stools in infants. Celexa has been connected to difficulty sleeping, reflux, and a loss in muscle tone. However, this information comes from small samples of kids.
If you started taking one of these antidepressants during or before your pregnancy, make sure to check in with your healthcare provider. Most of the time, they will recommend you continue taking the same medication — no matter which one it is. It’s usually better to keep taking a medication that’s working (or to stick with one that’s worked well in the past), even if it’s not a usual first-choice medication for breastfeeding.
Your healthcare provider can help you navigate the risks and benefits of taking an antidepressant while breastfeeding. The best medication usually boils down to your medical history, your symptoms, and what has worked well in the past.
My medication wasn’t listed above. What does that mean?
Many other antidepressants are available; this list isn’t exhaustive. If you take an antidepressant that wasn’t listed above, it likely doesn’t have much safety data among breastfeeding mothers. Other common antidepressants include:
Lexapro (escitalopram)
Pristiq (desvenlafaxine)
Norpramin (desipramine)
If you take one of these antidepressants, your healthcare provider can give you more information about next steps. You’ll likely be able to keep taking it if you’re planning on breastfeeding your child, but your provider can help you understand the potential benefits and risks.
The bottom line
All antidepressants pass into breast milk. But for many antidepressants, the risk to your baby is small. And experts agree: for most people, the benefits of breastfeeding — and of getting treated for PPD — both outweigh the risks of taking an antidepressant while nursing.
If you do decide to take an antidepressant while nursing, there are many good options available. Zoloft is considered one of the safest antidepressants to take while breastfeeding. Paxil, Pamelor, and Tofranil are also recommended options. Prozac, Celexa, and Effexor may be connected to more possible short-term side effects, but if they’ve worked for you in the past, they might still be worth considering.
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References
Berle, J. O., et al. (2011). Antidepressant use during breastfeeding. Current Women’s Health Reviews.
Di Scalea, T. L., et al. (2009). Antidepressant medication use during breastfeeding. Clinical Obstetrics and Gynecology.
Drugs and Lactation Database (LactMed). (2022). Mirtazapine.
Drugs and Lactation Database (LactMed). (2022). Nortriptyline.
Drugs and Lactation Database (LactMed). (2022). Sertraline.
Drugs and Lactation Database (LactMed). (2023). Bupropion.
Merwar, G., et al. (2023). Nortriptyline. StatPearls.
