PEBC MCQ Special Populations & Other Therapeutics question: postpartum depression requiring an antidepressant

PEBC MCQSpecial Populations & Other Therapeutics

LB, 31, is breastfeeding her healthy 2 month old and has postpartum depression requiring an antidepressant. She has never taken one before. Which option is generally preferred?

a. Fluoxetine at high dose
b. Sertraline
c. Doxepin
d. Lithium

Show the answer and explanation

Answer: b. Sertraline

Sertraline transfers into breast milk in low amounts and is generally considered a first choice during breastfeeding, with infant monitoring. Fluoxetine has a long-acting metabolite that can accumulate in infants, lithium reaches significant infant levels, and doxepin has been associated with infant sedation and respiratory depression. Untreated postpartum depression carries risks for mother and baby. Source: CANMAT 2023 MDD update, perinatal depression (Can J Psychiatry 2024;69:641); LactMed, Sertraline (NIH, updated 2024).

Common mistake

Assuming all antidepressants are equally suitable in lactation.

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