Data have accumulated over the last few years on the use of antidepressants in nursing mothers. It appears that all antidepressants are secreted into the breast milk; however, the amount of medication to which the nursing child is exposed appears to be relatively small. We have the most information is available for fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), and the tricyclic antidepressants. In general, one should try to choose an antidepressant for which there are data to support its safety during breastfeeding. However, there are often situations where one may choose another antidepressant that has not been as well characterized. For instance, if a woman has not responded well to any of the above medications.

To date, there has been only one report on the use of bupropion in two breastfeeding mothers. Serum levels of bupropion and its metabolite were undetectable in the infants, and there were no observed adverse events in the nursing infants. While this information is reassuring, further study is needed to fully determine the effects of bupropion in nursing infants.

In general, the risk of adverse events in the nursing infant appears to be low. The child should be monitored for any changes in behavior, level of alertness, or sleep and feeding patterns. In this setting, collaboration with the child’s pediatrician is essential.

Ruta Nonacs, MD, PhD

Baab SW, Peindl KS, Piontek CM, Wisner KL. 2002. Serum bupropion levels in two breastfeeding mother-infant pairs. J Clin Psychiatry 63: 910-1.