ABSTRACT
OBJECTIVE: Pharmacological treatment of postpartum depression is frequently complicated by the mother's desire to breast-feed. Although breast milk levels of several selective serotonin reuptake inhibitors (SSRIs) have been reported to be relatively low, a critical question is whether SSRI exposure during nursing results in clinically significant blockade of serotonin (5-HT) reuptake in infants. This study determined the degree of transporter blockade in infants exposed to sertraline through maternal breast milk. METHOD: The extent of maternal and infant transporter blockade was assessed by measurement of platelet levels of 5-HT in 14 breast-feeding mother-infant pairs before and after 6-16 weeks of maternal treatment with sertraline for major depression with postpartum onset. Plasma sertraline and desmethylsertraline levels were obtained in 13 of these mothers and 11 of their infants. RESULTS: Marked declines in platelet 5-HT levels of 70%-96% were observed in mothers after sertraline treatment, 25-200 mg/day. In contrast, infants showed little or no change in platelet 5-HT levels after exposure through breast-feeding. Mean levels of maternal plasma sertraline and its major metabolite, desmethylsertraline, were 30.7 ng/ml and 45.3 ng/ml, respectively. Drug and drug metabolite concentrations in the infants were at or below the lower limit of quantitation. CONCLUSIONS: The data indicate that while mothers receiving clinical doses of sertraline experience substantial blockade of the platelet 5-HT transporter, platelet 5-HT uptake in nursing infants of treated mothers is unaltered. The observations suggest that mothers taking sertraline can breast-feed without appreciably affecting peripheral or central 5-HT transport in their infants.
Subject(s)
Breast Feeding , Depression, Postpartum/drug therapy , Infant, Newborn/blood , Membrane Transport Proteins , Milk, Human/metabolism , Nerve Tissue Proteins , Selective Serotonin Reuptake Inhibitors/therapeutic use , Serotonin/metabolism , Sertraline/therapeutic use , Blood Platelets/chemistry , Blood Platelets/drug effects , Blood Platelets/metabolism , Carrier Proteins/drug effects , Carrier Proteins/metabolism , Depression, Postpartum/blood , Depression, Postpartum/metabolism , Female , Humans , Membrane Glycoproteins/drug effects , Membrane Glycoproteins/metabolism , Milk, Human/chemistry , Milk, Human/drug effects , Serotonin/blood , Serotonin Plasma Membrane Transport Proteins , Selective Serotonin Reuptake Inhibitors/analysis , Selective Serotonin Reuptake Inhibitors/pharmacokinetics , Sertraline/analogs & derivatives , Sertraline/analysis , Sertraline/blood , Sertraline/pharmacokineticsABSTRACT
This report provides preliminary evidence for the efficacy of clomipramine in the treatment of young adults with autistic disorder. Four of five outpatients with autistic disorder showed significant improvement in social relatedness, obsessive compulsive symptoms, and aggressive and impulsive behavior with clomipramine treatment. These findings are consistent with previous evidence, suggesting that serotonin neurotransmission may be relevant to the treatment, and possibly the pathophysiology, of some symptoms of autistic disorder.
