title: Serotonergic overstimulation in a preterm infant after sertraline intake via breastmilk.
abstract: The selective serotonin reuptake inhibitor (SSRI) sertraline is widely used as an antidepressant agent during pregnancy and lactation because of its low placental transfer and low level of excretion into breastmilk. Symptoms such as neonatal abstinence syndrome and serotonergic overstimulation have been reported after in utero exposure to SSRIs. These symptoms are self-limiting and usually peak within the first 48 hours after birth. In our case, a preterm infant was exposed to sertraline and its main metabolite desmethylsertraline in utero and via breastmilk. Beyond the first 48 hours after birth, the infant developed increasing clinical signs of serotonergic overstimulation associated with substance intake via breastmilk, until breastfeeding was discontinued on postnatal Day 9. In spite of a low calculated daily substance intake via breastmilk, the serum substance levels of the preterm infant were within the therapeutic range of adults. The serotonergic overstimulation may be explained by the limited metabolic capacity of the infant and the immaturity of the blood-brain barrier.
authors.affiliation: Department of Paediatric Cardiology and Intensive Care Medicine, Georg-August-University Goettingen , Goettingen, Germany. matthias.mueller@med.uni-goettingen.de
authors.forename: Matthias J
authors.initials: MJ
authors.lastname: Müller
authors.forename: Christoph
authors.initials: C
authors.lastname: Preuß
authors.forename: Thomas
authors.initials: T
authors.lastname: Paul
authors.forename: Frank
authors.initials: F
authors.lastname: Streit
authors.forename: Gunnar
authors.initials: G
authors.lastname: Brandhorst
authors.forename: Stephan
authors.initials: S
authors.lastname: Seeliger
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D001812:Blood-Brain Barrier; D003866:Depressive Disorder / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D041943:Infant Formula; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D008895:Milk, Human / Q000378:metabolism*; D009035:Mothers; D011247:Pregnancy; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D020280:Sertraline / Q000008:administration & dosage / Q000009:adverse effects* / Q000097:blood; D014202:Tremor / Q000139:chemically induced
chemical_list: D000928:Antidepressive Agents; D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline