Mirtazapine and Breast-Feeding
Ms. A, a 27-year-old woman, was admitted to a psychiatric hospital 3 weeks after delivery of her daughter. She was suffering from a severe depressive episode with suicidal thoughts. Ms. A had a history of a first depressive episode at age 18 that was not treated. At the time of admission to the mother-child unit, Ms. A was breast-feeding her child and had so far not received antidepressive treatment. A routine diagnostic assessment, including a physical examination, laboratory studies, and a cerebral computerized tomography scan were normal. Treatment with sertraline, 150 mg/day for 11 weeks, was not effective. Therefore, Ms. A was switched to mirtazapine, 30 mg/day at 9:00 p.m. She fed her infant six times a day. Concentrations of mirtazapine were determined in breast milk and in the serum of mother and infant by using mass spectrometry after Ms. A provided written informed consent and the study was approved by the local ethics committee for measurement of her and her infant’s serum levels of the drug. Samples were taken after reaching steady state before breast-feeding, the first time at 7:00 p.m. (22 hours postdose) and a second time at 12:00 a.m. (15 hours postdose).At 7:00 p.m., the maternal plasma level of mirtazapine was 7 ng/ml (therapeutic range=5–100 ng/ml); the same level was found in the foremilk (the early portion), whereas in the hindmilk (the later portion), a concentration of 18 ng/ml was detected. On the next day at 12:00 a.m., the maternal plasma concentration was 25 ng/ml; in the foremilk, a concentration of 28 ng/ml and in the hindmilk, 34 ng/ml were found. The infant’s plasma concentration was 0.2 ng/ml. The body weight of the infant was 6.8 kg at this time.Ms. A was discharged in remission after 6 weeks of mirtazapine treatment. The psychomotor development of the infant was normal, as rated by an experienced neuropediatrician. No adverse events related to the mother’s mirtazapine intake could be detected; especially, there was no sedation or abnormal weight gain.
Reference
Information & Authors
Information
Published In
History
Authors
Metrics & Citations
Metrics
Citations
Export Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
There are no citations for this item
View Options
View options
PDF/ePub
View PDF/ePubGet Access
Login options
Already a subscriber? Access your subscription through your login credentials or your institution for full access to this article.
Personal login Institutional Login Open Athens loginNot a subscriber?
PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.
Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).