Exhaustion, nursing and depression

Hi BPN,
My daughter was born 5 days ago by a c-section and I seem to be caught in a downward spiral. I am trying to nurse her exclusively and am finding she needs to be nursed every 2 hours or so. She doesn't seem to like being swaddled and wiggles at least one arm free if not both, but it seems the only way she will continue to sleep after nursing without someone holding her is to be swaddled - that's what they did at the hospital. My husband and I are trying to learn how to become better swaddlers. If you have any tips/advice/gear that is great.

This inability to put her down is wreaking havoc for me - I am now at 7 days and counting (labor started 7 days ago) on 2 hours of sleep a night. I ended up with a c-section and the sleep interruptions continued the 4 nights in the hospital. At this point I am exhausted, weepy with pp blues and unable to sleep for more than 1 hour at a time even when I get a chance. My eyes automatically pop open. The exhaustion is causing depression and the depression I suspect is not allowing me to stay asleep and is causing further exhaustion. I am so exhausted I am literally crying. How do I break out of this cycle? I want to enjoy my newborn and do the right thing for her. I ended up supplementing with formula for my first born for a number of reasons and wanted to do it right this time. How do other c-section moms cope between the pain and sleep deprivation? How do I break out of this cycle? I am getting so upset/worried about not being able to sleep I think that's becoming a cause itself... Sleepless new mama

Can you afford a postpartum doula, even for 1-2 nights? You might consider the overnight help, but it is EXPENSIVE. Such a person would sleep on your couch, bring the baby to you for nursing, but she would do everything else - swaddle, diapers, etc. And would likely help you out by making breakfast, tidying before she left, etc. Something to consider if you can swing it financially. If not, this is the time to ask for such help from friends or family. There are few times in our lives when we really need to ask for help, and this is one of them! Is there anyone you can have just help for 1 night or 2, so you can get ''centered'' again?

Finally, it will get better! Also, talk with your doctor and your baby's doctor about how you are feeling. They can help, but only if they know how you are feeling. Your hormones will get more in balance each day ... Take care The first three months are tough going!

I highly recommend reaching out to your doctor to get medication for depression/anxiety. Zoloft is safe to take while breastfeeding. Initially I didn't want to take Zoloft, but things weren't getting better for me. A nurse practitioner spent over an hour with me talking about the pros and cons of Zoloft and she said that it is a "necessary medication" for me, no different than if I had high blood pressure and was prescribed medication for it. That really resonated with me and I started taking it. It has helped me tremendously and today I'm enjoying everything about being a first time mother. Looking back I really regret not taking the medication sooner.

I also recommend taking daily breaks away from the baby, i.e., some "me time." This is similar to taking breaks at work. If you don't take breaks, you will not be effective at work. But more importantly, take breaks and do things that make you happy. Get a massage, go for a walk, etc.

The last bit of advice is not to stress if you need to supplement with formula. I felt a tremendous amount of pressure to exclusively breast feed and this caused me extreme anxiety. I learned that it isn't the end of the world. Your baby is satisfied and sleeps longer, you get a break and some sleep. Remember, a happy baby = a happy mom and a happy mom = happy baby. I do a combo of breast milk and formula today and it works for us. Good luck to you. Feel free to email: jntkim@yahoo.com. happy new mom

My advice is to get a ''miracle blanket'' right now. It's safe - there's no velcro or anything, but it doesn't require anywhere near the amount of sophistication that a regular swaddling blanket does. The wrap is very tight and a little baby, no matter how squirmy, won't be able to get out. We also followed the Happiest Baby on the Block steps stubbornly - 40 minutes of rocking and shussing to get her to sleep sometimes - but after a couple of weeks of that she became, and still is, the best sleeper of any baby we know. Expect to be bummed for a little while. This is a huge change and your body has been through a massive trial. As my mom told me, each day you will feel a little better, until you feel good again. Try getting out and walking around the block. IT will hurt, but you'll feel better after. If you're still super bummed at 3 weeks, go to the doctor. I would also be happy to talk to you anytime, please get my email from the moderator if you want. back to normal

I truly feel you. I had very similar experience as yours. I had a long and hard labor which ended up with emergency C-section. Then the story was the same as yours: exhaustion, nursing struggle, and postpartum depression. I literally cried almost every day until my baby turned 3 months old.

I want to tell you that there is hope. Things got a lot easier after my baby turned 3 months old, when he stared to sleep through the night. My baby is now 14 months old, everything is becoming easier and easier and more and more fun. My baby makes me laugh many times every day, and I am so much enjoying the motherhood. Looking back, I felt those hard days were so short and time was flying by so quickly. All those hard work, including the depression and sleepless nights, are totally worth. Now to answer your questions:

1. To swaddle your baby, try HALO 100% Cotton Sleepsack Swaddle, which you can find on amazon: http://www.amazon.com/SleepSack-Cotton-Swaddle-Cream-Small/dp/B003E6OBMA/ref=sr_1_1?ie=UTF8&qid=1348681740&sr=8-1&keywords=halo+swaddle+sleepsack This swaddle can be used with arms in or arms out. I did not get this for my baby, but I really wish I did.

2. The sleep issue - Have you thought about hiring some one to help you? The first two months are the hardest, and if you have a little savings in your account, I think it is very worth to use that money now to get some real help. My parents were here to help me during the first two months, and I would have not survived without their help. You can either hire a daytime or nighttime nanny. You can pump and store your milk ahead and let the nanny feed the baby, and then you can have a longer sleep.

3. Is it possible for your husband to take a few weeks off from his work? Even 3 weeks will help tremendously. If he can, you can let him take care the baby at night so you can sleep. If he regularly takes vacation every year, why not taking vacation now to help you when you truly need help?

4. Do you have any relatives that may be able to offer help? Your parents, or in-laws? If they have the time but feel reluctant to have to work hard, you can hire a nanny to do the hard part and ask your relatives to just help to watch the baby.

I am so sorry for what you are going through. It is very hard, but there is hope and very soon (in a couple of months) you will feel things start to get easier and easier. once a depressed mom

Here is what I ended up doing: My husband set up an armchair and ottoman (feet up, with a support pillow under my knees). Before my husband went to bed (he couldn't help out during the nights because of a medical condition), he'd help me get in the chair. I realized I needed to hold my son close, and that, on a nursing pillow, he'd snuggle up to me and sleep peacefully for up to three hours at a time, sometimes longer. Skin contact with me meant that he didn't need to be swaddled. Throughout the night, my son would sleep and wake up once to nurse once in a while. I can't usually fall asleep sitting up, but I found that I was able to sleep, or at least get some rest, with my feet up and my son snuggling up to me. In the morning, my husband would help me lie down, and I'd often get some sleep in an actual bed for an hour or so. Of course, as I healed and was no longer in pain, and able to , things got much easier.

You sound like you are in a terrible, terrible spot, and you are so right about the cycle of sleeplessness and depression. Can you get someone to help out for 1 night, while you take a sleeping pill and get one night's rest? Marathon laborer

That one stretch of 6 uninterrupted hours made all the difference in the world. You should try to work something like this out with your partner, so that each of you can get enough sleep to get by. It is more important that you sleep to the point that you feel rested, than that your baby gets only breastfed. Karen

To address some of the details you brought up: Feeding every 2 hours sounds about right to me. At night we were able to stretch it to every 3-4 hours, but during the day our daughter definitely fed every 2 hours. I am not good at napping during the day, but I would try to rest when she did, and at night I was so tired I usually fell asleep as soon as she was done eating. Worrying about supplementing with formula: You mentioned that this time you want to ''do things right'' and I applaud your commitment to exclusively breastfeeding. But I also want to encourage you to ease up on yourself a bit as well. This added pressure is probably adding to your restless brain, which is keeping you awake. Go see/call a lactation consultant and discuss your previous breastfeeding situation and your current goals. They should be able to help you. At Kaiser we had a LC appointment a week after our baby was born and she was very helpful in tweaking positioning and whatnot so my baby could nurse more efficiently, as well as easing some of my anxieties about ensuring she was getting enough food.

Please take care of yourself and allow yourself to have the spontaneous crying jags and the feelings that you are doing it all wrong, but always remember that you and your baby will figure out a rhythm and it will get easier. Maria

Your hormones will settle down and your body will recover and every day it will be easier. My baby is six months now and nursing is a joy, not the torture it was at first. It is so lovely to be close with my babe and no washing bottles or buying formula. You can do it. Get a lactation consultant you like. Go to la leche or other meetings to get moral support. You deserve cheerleaders. Nursing is hard but so worth it. was depressed and exhausted too

1) C-Sections disrupt the bonding hormones- so your child may feel more like a burden than a blessing. This is not all in your head. Don't blame yourself and make it worse. Blame the drugs, and know it will get better.

2) Depending on your metabolism it can take four to six weeks to flush the drugs from your system. These drugs gave me hallucinations and night terrors so that even when I could sleep, I wasn't resting.

3) Newborns come in many varieties, and mine slept for less than 2 hours a night to start as well. BUT- if it takes an adult four to six weeks to get the drugs out of her system, then doesn't this affect the baby? And if I'm troubled by night terrors, then could baby be experiencing something similar that is interrupting her sleep patterns? No doctor could answer this for me.

4) I had to allow myself time to grieve for the home birth experience I lost AND to process the body/mental trauma of being cut open. This is not a paper cut.

Suggestions: Nighttime dula, daytime dula, massage therapy, acupuncture, reflexology, chiropractic treatments, gentle herb cleanses and relaxing tonics/teas, warm Epsom salt baths, with lots of swaddling, rocking, and comforting for YOU- not just baby. Big C Mama

(1) If you are in physical pain post-surgery, take pain meds. Talk to your doctor, of course, but there are many, many options you can use that won't interfere with nursing or harm your baby. You do NOT need to live in pain. And if you are not yet moving around very easily due to the C- section, you need another adult to stay with you during the day. Your husband, your mom or another relative, or hire a post-partum doula. Do NOT be shy about getting help!

(2) It is NORMAL for babies to need to be held constantly 24/7 at first, and to nurse almost constantly too. (Nursing ''every 2-3 hours'' is an average, not a schedule; the actual intervals might be longer & shorter.) Please adjust your expectations! You don't need to put your baby down; you need to figure out how to meet her need for physical contact in a way that balances the physical & emotional needs of yourself and the rest of your family. Babywear. Cosleep. (Nursing, bedsharing new mothers get more sleep and feel MUCH more rested than bottle-feeding moms with crib-sleeping babies.) Spend more time in bed; it *does* help stave off exhaustion. Take advantage of every possible opportunity to let loving friends and relations hold the baby while you nap or shower or play with your firstborn. Somewhere between 4 & 12 weeks, your baby will begin to develop a more regular sleep pattern and to be more content to sit in a bouncer seat or the like on her own for longer stretches, and you will begin to emerge from the fog.

(3) It's also normal to be weepy in the first few weeks after giving birth; that's your hormones swamping your good sense. You will survive! Breastfeeding and babywearing help *reduce* the risk of post-partum depression, so don't be tempted to formula feed or sleep- train in order to get more rest; besides the associated risks to your baby's health, it wreaks further havoc on your hormonal balance. Get help with household maintenance and anything else you may be feeling responsible for; right now you are entitled! Recovering from birth and caring for your new baby are tiring under the best of circumstances. But if you don't feel like the ''baby blues'' are passing soon, or after another week or two you still can't sleep more than an hour at a stretch even when your baby is slumbering quietly in your arms, seek medical help. Post-partum depression is nothing to mess around with, and if you need a good counselor/therapist/psych, the sooner you see one the better off your whole family will be.

My very best wishes for a speedier recovery and a happier ''babymoon'' to you. Holly

Newborns sleep best swaddled with their arms straight at their sides to mimic the uterus. It's not a preference to have their hands at their mouths, it is just that the pelvis has kept them there for weeks and they tend to rest there. A great swaddle blanket you can get on-line is called ''the miracle blanket'', with velcro for the wrists. Parents swear by it. Please get some sweet dreams. midwife Lindy

Postpartum depression and Medication -breastfeeding, thinking about getting pregnant

I have been suffering from PPD for about 5 months but did not want to start medication becasue I was breastfeeding. It has gotten so bad that I need to do something. However, my husband and I also want think about having our second baby when our daughter reaches the one year mark (about 3 months from now) IF I am doing better. Has anyone been on antidepressants while nursing and/or duringpregnancy? Any info on how to deal with PPD would also be helpful. Thanks Krista

For me, I had to weigh the risks of SSRIs against the risks of being depressed during pregnancy and after my son came. My depressions are so debilitating, and so interfere with my ability to be a decent parent, that for me, using medication was absolutely the right choice. (I also did and do other things to try and minimize the risk of relapse, including meditation, exercise, healthy diet, etc.--but none of these alone were enough to overcome my vulnerability to depression.)

A good source of information about the safety of antidepressants (and other medications) during pregnancy is the California Teratogen Information Service at UC San Diego (http://ctispregnancy.org or 800-532-3749). You can call them and they will give you up-to-date information about the safety of different drugs during pregnancy. I used their service to aid my decisions, and even enrolled myself and my son in a longitudinal study with them. (BTW, my son is now 3 years old and is generally healthy and developing normally.)

CTIS also gives limited information about medications and breastfeeding but a good source of information about the safety of medications during lactation is Hale's book Medications and Mother's Milk (which any lactation consultant should have and can go through with you). I believe he also has a book written for parents. His website is http://neonatal.ttuhsc.edu/lact/index.html. Be well and take care of yourself K.D.

Please talk to your doctor and then call Shoshana Bennett (510) 704-0359- she is an expert in the area of PPD and can offer you a ton of research and resources anon

As for the PPD, again, I'm so sorry you're going through this. You need to have a safe place where you can talk about how you're feeling, whether or not you choose meds. Studies have shown that when women talk to other women, the hormone oxytocin is released, which has a calming and uplifting affect on the brain. Find a support group and/or find a therapist (Alisa Genovese, 286-7599, she's the BEST!) You have to talk about what's going on, even if you already are, you need to do it more! Feel free to contact me directly if you have any questions or want to talk more. Jill

Get on the drugs. The impact of mommy feeling good again will be incalculably positive on your child, and far outweigh what little chemicals are being passed on in your breast milk.

Consider giving yourself more time before getting pregnant again. Allow yourself to celebrate your daughter's birthday and think about how far you've come. Give your body time to figure out what drugs you need to take, and how much, and give yourself time to stabilize without a biological deadline pressing you. Enjoy yourself again. Pump a few bottles and take a night or two away from your family (yes you can!). And bear in mind, though you've been told many times already, that two kids is way more than twice the work of one. The difference to your fertility of waiting another year might not be an issue, but the difference to your emotional and physical readiness for handling the stress could be tremendous.

Consider couples counseling. It took another year after I started taking the drugs before I figured out how to articulate how ANGRY I was about a whole bunch of stuff at home and how SAD I was about my old life/self being gone forever. Giving those feelings voice made them less imprisoning, and things are still very hard, but now they are just ''things,'' not everything.

Hang in there! heidi

I also feel that doing talk therapy in conjunction was crucial for me. As for wanting to get pregnant again, hat's off to you. I can't imagine, in the midst of the PPD, having that desire AT ALL. Perhaps that's a good sign. It would be good to get info on the effects on a growing fetus, however. Also, be warned, it's very common for your sexual libido to disappear. Good luck to you. PPD is no fun. Mom who has been there

Breastfeeding and Exhaustion & Depression

I am wondering if weaning my 18 month old would increase my energy/mood levels and get my hormones back on track (I know weaning has its own hormonal issues!).

I am suffering from chronic exhaustion (sleep deprivation, along with the demands of caring for a toddler and my older school-aged child), depression (major, for which I am taking meds), and major hormonal swings which really got worse once my period started when my son was 13 months old.

I nurse my son when he wakes at 5:30am, then before he goes down for his nap and then again before bed.

I am hesitant to wean because I do enjoy the connection with him and he certainly enjoys it. However, If I knew for a fact that weaning would improve my energy/depression, mood then I would be willing to do it. I just don't know whether weaning will make enough of a difference or whether I should focus on other things to address these issue: like exercise, vitamins, etc. I am 42 and wonder if my age is also a factor in why I am so tired.

I would love advice/input on the connection between breastfeeding and energy/hormones/mood levels. another tired mama

I don't know for sure that weaning will directly affect hormone levels and depression, but I do know that eliminating the 5:30 a.m. feeding will! Can your husband/partner give him a bottle so you can sleep a little longer? If you could get him down to one feeding per day, preferably before bedtime, I think it would make a big difference, while still allowing you to keep that special connection. I nursed (and pumped) exclusively til my son was 12 months, and then my supply ran low so I cut back to just the one evening feeding. (I added rice milk because he is allergic to dairy and didn't like soy) It was a nice gradual way to eventually wean at 15 months (i had very little milk left at that point), and though it was bittersweet to stop, I felt like we were both prepared because it had happened so gradually. I was 41 when that happened, and I do believe age has something to do with it. There is a reason people do this in their 20's! I battle depression also (but I did before and after baby), and I would guess that perhaps weaning would have some effect on the way the meds work.

Give yourself some slack--you've done A LOT! Three times a day after 18 months is a tough pace to keep up. And it sounds like you are a SAHM too--which is also more exhausting than working away from home! Try eliminating the a.m. feeding for a week or two, then the mid-day one (assuming you can pump or that he can take a bottle of another kind of milk), and I think you will feel worlds better when you are down to one feeding at night. best of luck! anon

Anemia can cause depression and it certainly causes sheer exhaustion. Right before I was diagnonsed I was starting to realize something was really wrong because I would get out of breath from the easiest task. My husband kept saying I should see a doctor and I said ''oh it's just from taking care of a toddler...'' He was right and I was stubborn. anon

Paxil while breastfeeding

I am wondering if it is safe to take Prozac while I breastfeed my newborn, or if there are other similar drugs that might be a better alternative to Prozac. Any information, links to websites or personal experience about this would be more than welcome. Thanks

Recently, NPR had a story on postpartum depression and medication which can be found here: http://americanradioworks.publicradio.org/features/maternaldepres sion/index.html. The story featured Lee Cohen, M.D., who is at Mass General and is a leading researcher in the field of postpartum depression and medication. I also encourage you to talk to the health care provider who is prescribing the medication about your questions and concerns. Good luck. Mirjana

Canada Says Anti-Depressants May Harm Newborns, Post Reports Aug. 10 (Bloomberg) -- The Canadian government warned that popular anti-depressants taken by pregnant women can cause side effects in their newborns such as breathing problems, seizures and constant crying, the National Post reported. Some of the babies whose mothers took the medicines developed problems that required prolonged hospitalization, breathing support and tube feeding, the Toronto-based newspaper reported. Health Canada also said symptoms include muscle rigidity and jitteriness. The government's advisory cited drugs such as Eli Lilly & Co.'s Prozac, Pfizer Inc.'s Zoloft, Wyeth- Ayerst International's Effexor, Forest Laboratories Inc.'s Celexa, Solvay SA's Luvox, Akzo Nobel NV's Remeron and GlaxoSmithKline Plc's Wellbutrin and Zyban. The manufacturers are being asked to revise product monographs to reflect the concerns about the medicines, the Post said. Government officials and some experts said pregnant women shouldn't hastily reject the medicines because untreated depression may be more dangerous than some of the pills' possible side effects, the newspaper reported.

As someone who has long struggled with depression, I will add that antidepressants do take some patience to use. Finding the right dosage of the right drug (if you have a choice--which you may not while bfing) takes time. If this is your first time dealing with antidepressants, it really helps to work with a clinician who is both experienced in prescribing antidepressants AND who really listens to YOUR experience of the medication. Such people are not easy to find. Best wishes! kira

Anti-anxiety meds and breastfeeding

After being diagnosed with post-partum anxiety and depression I am considering medication (such as SSRI's). I have a on and off 10 year history of depression and anxiety (which has become progressively worse over the years) however I have yet to try medication. Up to this point I have experimented w/ numerous ''alternative'' drug-free approaches and frankly nothing seems to really work and I am tired of being a shadow of my former easy going, adventurous, happy self. Of couse now that I am finally willing to try meds, I am breastfeeding and weaning at this point (my baby is 2.5 months old) is not an option for me. I am interested in other women's experience with anxiety/ depression meds while breastfeeding. Did they work? What did you take? How much? For how long? anon

There are only a few drugs that they will let you take while you are nursing and those may not be the perfect drug for you. There can also be a lot of trial and error with taking meds so you have to be patient. For me, 2 milligrams can make the difference between happiness and being a zombie. I would recommend finding a doc you really trust. Good luck!!!! Life is good on Paxil

Effexor & Klonopin while nursing

I have been struggling for months now with depression and anxiety, and have just been prescribed effexor (anti-depressant) and klonopin (anti-anxiety) for treatment. I am, however, still nursing my now 20-month old son and am wondering if there is anyone out there who has had experience with either medication or both. I would really appreciate some feedback in regards to your experience on your own well-being with the medication(s) as well as your child's, if you were also nursing while taking the medication(s). I am having some trouble making the decision to either take them or not, due to the fact that I'm still nursing. However, therapy alone has not helped to alleviate my outlook and mood, which is why my doctor has suggested medication. I appreciate any and all responses. Thank You!

Klonopin is a valium-family drug, the only one in this group that is considered appropriate for long-term use. It's mainly an anti-seizure drug; I was put on it for several years to control neuropathic pain. It will make you very sleepy -- it's also used as a sleeping pill -- and though you will acclimate to the sleepiness, it won't really go away. Like all valium drugs, it's potentially addictive, although less than most because there's no ''high.'' To go off it, you need to taper off over several weeks because of potential seizures, even if you've never had a seizure. All this makes it sound serious, maybe more serious than it may really be.

I'm curious why you would be prescibed Klonopin if you're depressed, because it can exacerbate depression, and there are antidepressants that also control anxiety.

I believe Effexor is an SSRI, which means it can have an effect on sex drive and functioning. I was put on Paxil, also an SSRI, for neuropathic pain and depression. The initial dose was pretty usual but way too high for me, and made me manic for a week before I crashed. At half that dose I was cheerful and had zero interest in (and no ability to focus during) sex while feeling vaguely aroused much of the time. There are some entertaining SSRI-side-effects websites telling stories about no sex drive coupled with spontaneous orgasm in inappropriate circumstances, such as in line at the bank, which (given my experience) sounds plausible. At this time I take about 1/4 the original prescribed Paxil dose plus an antiseizure drug for the neurological stuff.

Re depression: If you go on meds, please continue psychotherapy. Even if depression has a physical cause alone, drugs aren't enough to deal with it. It's also important to do active stress management, spend time with friends, *plan* for fun activities, and get enough exercise (while caring for your child!). A combo of aerobics and something meditative like yoga, tai-chi, chi-gung, or Kum Nye can make a huge dent in depression, and I find supports the effect of meds.

You say you have depression and anxiety: depression is a high-energy state where the energy (often anxious energy) is turned inward and eddies away erosively inside. Hence you can be fatigued and overwhelmed while not getting much done. Meditative practices can slow the internal hurricane and free some of the energies the hurricane is consuming. I know that depression makes it hard to take the needed self-care steps: please remind yourself that it's worth it -- and get your therapist to help you on this. The best place for the meditative practice is in a class, because it's hard to do meditative practices when depressed and anxious, and you may feel like you're failing because you won't feel at all as serene or focused as you may think you should. This is a common experience in meditation. A teacher can help you with this.

Please note that if you go on meds, you may have to try several before you find one that has the right effects (and minimal side effects) for you. And I'd advise starting at the lowest possible dose, which may be much lower than what the doctor recommends, and slowly increasing from there. If possible, start with one drug only. Hang in there -- I know this is tough. anonymous

Did anyone out there take antidepressants while breastfeeding?

My pregnancy was normal except for some high blood pressure in the last month. My son was over 11 pounds, and his only health problems were related to his large size. He was not jittery -- on the contrary, he was difficult to rouse for feedings! I'm still breastfeeding and still taking 40 mg of Paxil because my doctor and I both think that the mother's positive mood and breastmilk outweigh the risks from the Paxil.

There is a great book that you can buy called "Medications and Mother's Milk" By Thomas Hale. This book lists almost every medicine (and some herbs) out there and lets you know if the medication will get into your milk, how much, if it is safe, etc. It sells on Amazon for $25, but I have heard you can find it cheaper through other net sources. Good luck.

Shoshanna Bennett 510-727-4610 specializes in Postpartum Emotions and is totally up to date on all medications and breastfeeding. She offers individual consultations as well as groups. We in the Bay Area are lucky to have her as a resource.

My understanding is that Paxil and Zoloft are increasingly being prescribed for breastfeeding mothers. They have not been around as long as the tricyclics for treating depression, but initial studies seem to show very small amounts in breastmilk and no evidence of buildup in baby's serum. (The levels of Paxil have been measured in a mother's breastmilk, and were found to be extremely low, about 0.34% of the maternal dose (J Clin Psy,1996.)

Two Books which women have found useful are:
This Isn't What I Expected, by Karen Kleiman and Valerie Raskin
I Wish Someone Had Told Me, by Nina Barrett

Organizations: Depression After Delivery (D.A.D.) 800-944-4PPD

Postpartum Support International (PSI) 805-967-7636

Postpartum Stress Center & offices of Karen Kleiman 610-525-7527

Here is some information that was posted on another list I was on that was for breastfeeding/pumping moms. (The original author said it was Ok to pass it on.):

There is controversy over whether or not Prozac (Fluoxetine) is okay to take while bfing. Some doctors say Yes and some say No. According to Hale's, the AAP says "Drugs whose effect on nursing infants is unknown but may be of concern."

The entry in Medication and Mothers Milk on how much Prozac gets into the milk is lengthy here is an attempt to paraphrase it: In one study, it seemed like infants were getting 5-9% of the maternal dose. However, in another case severe colic, fussiness and crying were reported in an infant whose mom was receiving 20 mg a day. Concentrations of fluoxetine & norfluoxetine where 340 ng/mL and 208 ng/mL respectively which is almost twice that of normal maternal range. It seems that the infant was getting about 2x what the infants in the other study were getting. When the mom discontinued the drug, the infant got better. Hale reports that he doesn't know if this situation is common but he's received 3 other reports where this happened.

Hale does list two possible alternatives, Sertraline (Zoloft) and Paroxetine (Paxil) which apparently have more trouble entering both the milk and the infant.

Also here is a good article on PPD and BFing and it has lots of links to other info on the subject: http://www.geocities.com/Heartland/Prairie/3490/ppd.html

And here are some other links about meds and PPD:

http://www.usnews.com/usnews/issue/000214/nycu/breastfeed.brf.htm
http://www.parentsplace.com/expert/lactation/medications/qa/0,3459,6128,00.html
http://www.parentsplace.com/expert/lactation/medications/qa/0,3459,8792,00.html

Here's an article from Pediatrics (the Journal of the AAP) which basically says that taking anti-depressants and bfing is compatible:

And here is some info about BuSpar if you are looking at that alternative: Hale's says: Buspirone (Trade name BuSpar) No data exists on excretion into human milk. It is secreted into animal milk, so would expect the same in human milk. BuSpar is mg for ms equivalent to diazepam (Valium) in it's anxiolytic properties, but does not produce significant sedation or addiction as the benzodiazepine family. It's metabolite is partially active, but has a brief half-lfe (4.8 hours) as well. Compared to the benzodiazepine family, this product would be a better choice for treatment of anxiety in bfing women. But without accurate breast milk levels, it is not known if the product is safe fro bfing women or the levels the infant would ingest daily. The rather brief half-life of this product and its metabolite would not likely lead to buildup in the infants plasma.

This is from the 7 Ed. of Hale's. There is a later edition and it conceivably could have more data on transfer to human milk that would give you something to go on. What I get out of this is that it's probably better than valium for a bfing mom. It's unclear if it would be better than Zoloft or Paxil. Valium, in case you are interested, is listed as "drug whose effect on nursing infants is unknown but may be of concern".

In general, with *any* anti-depressant, even one generally considered safe while bfing, the infant should always be monitored in some way. This could be as simple as just watching for changes in behavior esp. excessive sleepiness or lethargy or as thorough as bringing the infant in for tests periodically. The details are something you would work out with your doctor.