Agomelatine in breast milk.

Postpartum depression with a prevalence of 10–15% (Gavin et al. 2005) is characterized by social retreat, feelings of hopelessness and guilt as well as the inability to feel gratification in the mother’s role. A combined treatment of postpartum depression with antidepressant psychopharmacotherapy and psychotherapy is to be preferred in moderate to severe depressive episodes and is the choice of the majority of mothers (Lanza di Scalea & Wisner, 2009). Under breastfeeding, pharmacotherapy of postpartum depression is restricted to a limited number of substances with current favouritism of sertraline, paroxetine and nortriptyline (Burt et al. 2001; Lanza di Scalea & Wisner, 2009), although all three show detectable levels in the infant’s plasma (Fortinguerra et al. 2009). The efficacy of the antidepressant agomelatine has broadly been demonstrated both in preclinical and clinical trials (Fornaro et al. 2010; Kennedy & Emsley, 2006). Due to the small impact on other receptors, only a few side-effects and good tolerance, the rates of discontinuation of treatment are low (Kennedy & Rizvi, 2010). Agomelatine has a short plasma half-life of 1–2 h and an absolute bioavailability of 5–10% due to its high hepatic first-pass metabolism. Because neither preclinical nor clinical data exist, we sought to investigate the levels of agomelatine in the breast milk of a patient suffering from a depressive syndrome, hypothesizing that levels of agomelatine in breast milk show a plasma-equivalent early depletion.