Paroxetine and sertraline are the Selective Serotonin Reuptake Inhibitors (SSRIs) of choice. Recommendations apply to full term and healthy infants only.

General considerations

It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.

This article includes commonly prescribed selective serotonin reuptake inhibitors (SSRIs). Tricyclic antidepressants (TCAs), duloxetine, mirtazapine, trazodone and venlafaxine are covered separately. Many other antidepressant medicines are also available, and may need to be added in various combinations for more specialist situations. Contact our specialist service for further advice.


Paroxetine and sertraline are the SSRIs of choice during breastfeeding.

More evidence is available on the use of SSRIs during breastfeeding than other antidepressant groups and limited data show encouraging outcomes when considering longer term effects on infants.

However, they all have relatively long half-lives. This could result in accumulation and increased risk of side-effects due to an infant’s underdeveloped clearance capacities, particularly in the neonatal period.

Paroxetine and sertraline have shorter half-lives and pass into milk in smaller amounts compared to others, and are therefore preferred.

The National Institute for Healthcare Excellence (NICE) advises avoiding sharing a bed with the infant when sedating medication has been used, due to the increased risk of sudden unexpected death in infancy.

Recommendations apply to any indication the medicine is being used for such as generalised anxiety disorder, obsessive compulsive disorder or neuropathic pain.

Choice considerations

Untreated or inadequately treated depression can have adverse effects on the mother and infant and it is important that the mother receives effective treatment and does not stop taking it suddenly.

Treatment choice should primarily focus on controlling the mother’s symptoms. Suitability in breastfeeding is a secondary consideration.

There is no need to change an SSRI used successfully during pregnancy to a preferred choice in breastfeeding as long as the infant has been born full term and healthy.

Discontinuation syndrome

SSRIs can cause discontinuation symptoms if stopped abruptly, and occurs most commonly with paroxetine. This may make it more difficult for a breastfeeding mother to stop treatment and should be considered when making medicine choices.

Neonatal withdrawal syndrome

A specific withdrawal syndrome has been reported in infants exposed to SSRIs later in pregnancy, most commonly with paroxetine.

Symptoms include poor adaptation, jitteriness, irritability, poor gaze, agitation, hypotonia, and gastro- intestinal disturbances. Symptoms typically last 1 to 2 days (potentially longer with fluoxetine), but should resolve without intervention. Continuing breastfeeding may relieve withdrawal effects.

It may be difficult to distinguish between neonatal withdrawal symptoms and potential side-effects from SSRI exposure through breast milk. Symptoms common to both include agitation, jitteriness, hypotonia, and gastro-intestinal disturbances. Sedation has only been reported after exposure through breast milk. If symptoms do not resolve a few days after birth, consider that side-effects may be the potential cause.

Effect on breastfeeding

Those taking an SSRI may have more difficulty breastfeeding, particularly with establishing breastfeeding. The underlying disease state may contribute to this and additional breastfeeding support may be required.

Specific recommendations

Patient Information

The NHS website provides advice for patients on the use of specific antidepressants in breastfeeding.

Contact us

Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service if you need support in the following situations:

  • you need further advice
  • the antidepressant in question is not included in our advice
  • the infant is unwell or premature
  • multiple medicines are being taken

About our recommendations

Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.

If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.


Full referencing is available on request.

Update history

  1. Added links to other antidepressant pages. Added statement from NICE relating to bed sharing
  1. Title, URL and summary amended.
  1. Published

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