Sertraline Breastfeeding — MRCPsych Paper B MCQ

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EasyPerinatal PsychiatrySertraline BreastfeedingMRCPsych Paper B

A woman with postnatal depression is breastfeeding a healthy, full-term infant. She has not previously taken an antidepressant and, following an individual risk–benefit discussion, an SSRI is to be started. Which SSRI is a preferred choice because it passes into breast milk in very small amounts and infant serum levels are usually very low or undetectable?

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Correct answer: B — Sertraline

Sertraline is the preferred answer. UK specialist medicines guidance identifies sertraline as an SSRI of choice during breastfeeding in a healthy, full-term infant. Only very small amounts enter breast milk, and infant serum concentrations are usually very low or undetectable. Fluoxetine is less preferred because its long half-life and active metabolite increase the potential for infant accumulation. Citalopram and escitalopram can be used cautiously, but their milk transfer is generally greater and sertraline is preferred. Evidence for fluvoxamine is more limited, so it is not the standard UK first choice in this setting. If a woman were already stable on another effective SSRI, switching solely because of breastfeeding would not necessarily be appropriate.

Reference: NHS Specialist Pharmacy Service, Using SSRI antidepressants during breastfeeding, specific recommendations: Sertraline, updated 17 November 2023. https://sps.nhs.uk/articles/using-ssri-antidepressants-during-breastfeeding/