Antidepressants & Depression while Breastfeeding
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Antidepressants & Depression while Breastfeeding
June 2006
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
Seems like you should resolve your PPD before you even start to
even think about another child. Pregnancy will probably just
worsen things. Get a good psychiatrist who is used to working
with nursing moms. Then once you tackle that, talk to your
psychiatrist AND OB about what you should do for #2. Personally,
I have gotten off meds prior to conceiving every time but that is
a decision you and your docs should make.
Fellow PPD sufferer.
As someone who has experienced episodies of major depression for
much of my life, I took antidepressants during both my pregnancy
(Celexa, then Zoloft) and post-partum period (Paxil). I
nursed/pumped for a few weeks after my son was born but a
combination of my PPD and latch problems cut short my
breastfeeding plans.
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.
I nursed my daughter for three years and my son for 20 months
while on Zoloft. PPD is a serious disorder and the ''side
effects'' can be detrimental. I did a lot of research and felt
convinved that Zoloft was safe for me given the risks to myself
and my children without treatment. While pregnant with my first,
I did try lots of alternatives to meds, because of course I was
concerned with the health of my children. However, I have major
depression- the type that doe not generally respond to herbs and
other non-medical treatments. I credit Zoloft with saving my
life and possibly my children's lives.
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
I had PPD with my first and I know what you're going through, I'm
sorry you've had to suffer with it for so long, mine only lasted
for 6 weeks because I chose to stop nursing and start taking
Prozac. When pregnant with my second, I stopped the
antidepressants but shortly realized that my brain was not okay
with that, and when things once again started falling apart, I
went back on but switched to Zoloft, since it's the only SSRI
that's been studied in nursing women and has been shown not to
pass into breastmilk. The problem with medications and being
pregnant and nursing is that there are so few studies out there,
(because who wants to make their child a guinea pig?) which
leaves us with very little substantial information about whether
or not they're okay to use. So doctors will use the risk v.
benefits approach: knowing what you know, which is admittedly
little, do the risks of not taking the drug outweigh their
benefits? In my case they did, so I took them, and am a MUCH
happier person for it. You need to figure out which option is
going to work for you.
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
Hey Krista,
I waited until my daughter was 10 months old before taking
antidepressants, because I was a little concerned (and my spouse
was totally paranoid) about the drugs going into the breast milk.
I'm sorry I waited so long. What a relief a little Zoloft can
give a person! It's like I got a whole new life. I stayed on it,
on a reasonably low dose (about half the average daily dose),
throughout my pregnancy with our second daughter, with no ill
effect. I missed a lot of joy when my first one was tiny, because
everything was so hard and I was having so much trouble managing.
But with her little sister I've been laughing since day one. Now
I have no intention of ever not taking Zoloft, or whatever they
come up with next. My glass is half-full instead of half-empty
pretty much all the time now, and that's the best thing I can
give myself and my family.
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 have been there, not that any two cases of PPD are exactly
alike. I was completely against taking meds, and spent months
trying all kinds of natural stuff, all to no or little avail. I
finally yielded because the situation felt much too desperate. I
went on a very small dose of ZOloft (took 1/2 of a 50-mg pill),
and felt results within days, literally. I read as much as I
could about the effects on nursing babies, as I really wanted to
keep nursing and didn't want to harm my child. I didn't start
taking the meds until my child was 9 months old. But in
hindsight, I should have started earlier. I mean, I was so
miserable, and I think that affected the whole family much more
than some residual SSRI. That being said, I read something in the
past couple of months about a study that did indeed show that
breastfeeding infants do get some side effects. I think the study
focused on Paxil, though, and I am not sure of the ages of the
babies. I know that, at this point, Zoloft is believed to be the
safest.
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
I urge you to think long and hard about the decision to have a second child so quickly.
In the best of circumstances, it is incredibly stressful to have a young child--to have
two in diapers, even if you are feeling well, may be asking for trouble. Could you wait
another year or so?
anonymous
I have 2 children spaced 22 months apart. After my first was
born, I was euphoric, full of energy and couldn't hardly wait
until I could have another. After my second was born, I had a
series of minor complications and a major problem with PPD. I'm
not medicated and have no comment to make there. BUT, I can say
that having a second child so soon after your first, even if
you're feeling great before you get pregnant does not bode well.
Two children as stressful -- even if they're both really great
babies (sleep all night from the beginning, no colic, rarely
sick, eat well, happy) as my two kids are. PLEASE think of your
child and future child. They require all that you have to give.
With PPD, that's quite limited. Fortunately, my husband has been
able to be home a lot, which has helped me come to the surface
and I'm starting to feel better after nearly seven months. If I
could do it again, there would be a MUCH greater space between my
kids.
anon
April 2005
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
Weaning, by itself, isn't likely to result in your son sleeping later in
the morning, and weaning a toddler who isn't ready to be weaned is
exhausting. Especially at 5:30 a.m. So I think perhaps you should
explore other avenues first!
Mom of one weanling and one nursling
I breastfed my girl for 12 months and my boy for 9 months. I was glad
to do it, but also very glad when I finished - especially with the
second. I felt so much better physically when he was weaned. My energy
level definitely improved (FYI,I weaned my son when I was 39). I
woudn't say my mood changed much. And frankly, I think my son prefers a
bottle. I too thought he'd miss breast feeding, but I don't think he
has for a second.
anon
First, let me say that you have already done a WONDERFUL thing by
nursing for 18 months! You deserve a giant pat on the back for that!
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
Hi,
Wow, I feel for you! I wanted to write you back because in my case,
while I LOVED nursing my daughter and had initially planned on doing it
for at least 18 months if not longer, I had to stop.
I stopped because of exactly what you are describing - exhaustion and
depression - when my daughter was about 11 months old. And you know
what? I felt SO much better in about a month.
It made a HUGE diference to my body.
Been there
After recently weaning my 15 month old my moods got worse not better.
It's been about 3 months since then and I am starting to get used to the
ups and downs of a the monthly hormonal cycle and mood swings. I must
say it took me by surprise to be so subject to the power of hormones
again. Things I took for granted, like good skin, are now gone. And
I've put on some weight. My exhaustion is about the same. I have
struggled with depression in the past, but the last few years have been
depression-free and I continue to feel stable in that way. I don't want
to discourage you from weaning--I have no regrets. Weaning for me was
somewhat symbolic of my readiness to put my needs back on to the
priority list. That felt really good. My connection to my daughter is as
strong as ever. I was nursing about as much as you are and then cut
everything out but the night time feeding. We did that for about a month
and then stopped. She was fine with it. My advice is to cut out the
5:30am feeding TOMORROW. See how you feel in a week or two and take it
from there. In addition, make more time for yourself and get some kind
of exercise every day. I think this will do more for your exhaustion
and depression than anything else. It's so hard, I know.
In the same boat
breasfeeding made me exhausted. I feel much better since I weaned at 13
mos. sad, but true.
You should see a doctor and get some blood work done. I too was
EXHAUSTED when my baby was that age and also slightly depressed.
I became pregnant again and when I had my labs done I discovered I was
very anemic. I think this is common if you are breastfeeding but not
taking prenatal vitamins for the extra iron. Anyway, I went on iron
supplements and increased my iron content in food and started cooking in
cast iron and my energy and definitely my mood got much better.
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
I would like to give my experience here. I got very depressed AFTER
weaning my two year old. Our bodies produce a hormone called oxytocin
(sp?) when we beastfeed that makes us (mama and
baby) feel euphoric. I went through a couple months of ''withdrawl''.
Just another perspective.
sad weaner
Aug 2004
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
While I am not a psychiatrist and do not prescribe medication, I
am a psychologist who works with women experiencing postpartum
mood disorders. I strongly encourage (all) women to educate
themselves about their mental and physical health in order to
make the choices that are best for them. You may find the
following website helpful:
http://www.womensmentalhealth.org/topics/breastfeeding.html. It
is the website for Massachusetts General Hospital's Center for
Women's Mental Health and is a good resource for all women (it
has information on PMS and on psychiatric disorders during
pregnancy, postpartum and during menopause).
Be sure to also click on the ''Frequently asked Questions''
and ''Visit Our Women's Health Library'' sections for more
information.
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
Thanks to the support of this network I decided to take an
anti-anxiety med and it has made a HUGE difference. I am now feeling
quite HAPPY and fulfilled as a new mom (it took about two weeks to
kick in). Zoloft is the first drug of choice for nursing mothers,
but I believe prozac is the runnner up.... see Dr. Sears baby book
for more info.
- happy mama
A friend of mine is just now completing a scathing book on
antidepressant addiction, and I'll include some stuff from his
book in this email.
Also, I'd recommend a book called: The Anti- Depressant Fact
Book: What Your Doctor Won't Tell You About Prozac, Zoloft,
Paxil, Celexa, and Luvox (Perseus Publishing; paperback, 2001).
To tell the truth, I have no specific idea what the answer is
to your problem. I only know that we allow much broader use of
antidepressants in this country than they do in Europe, and
that many of them are really addictive.
Here's another book: Prozac Backlash: Overcoming the Dangers of
Prozac, Zoloft, Paxil, and Other Antidepressants with Safe,
Effective Alternatives by Joseph Glenmullen (Simon & Schuster;
2001) has a withdrawal chapter of 40 pages And here's another
one: Let Them Eat Prozac; The Unhealthy Relationship Between
the Pharmaceutical Industry and Depression (New York University
Press, 2004) by David Healy M.D., a well-reviewed history of
the how the drug industry manipulates regulators, physicians
and public opinion
Here is a quote from my friend's book (he's a medical
doctor): ''Many authorities believe that, just as with cocaine
addiction, newborn infants suffer through withdrawal when the
mother was using SSRIs such as Paxil, or when she was breast
feeding while using Paxil. ''
Since his book has not yet been published, I emailed him asking
about this and if I could mention his book. Here is his
response:
''There are numerous reports of newborn infants shaking in
withdrawal tremors because their mothers were taking
antidepressants. Similarly there are reports of infants
suffering from antidepressants transmitted through their
mothers' milk. In the UK they are much more aware of this
problem. There is a massive cover-up in America. For example,
Paxil's warning label in America spoke of only 0.2% withdrawal
problems but the same drug label in the UK spoke of 25%
withdrawal problems.
The same system is making is difficult for me to publish an
expose. Agents do not want to touch such a book, even though I
say NOTHING that is not already in the public record.
I am so upset at what is being done to Americans that I say you
can quote anything I wrote, even this. I have enclosed an
article that appeared on the Canadian Bloomsberg wire service
about what antidepressants may do to newborns. Breast feeding
infants are also similarly at risk.''
Good luck to you. cat
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.
When this issue came up for me, about 2.5 years ago, a
pediatrician that I trust said that Zoloft was the antidepressant
most studied with regard to safety during breastfeeding. My
brief web searches on medline, etc. confirmed this. I had been
on other antidepressants before my son was born and off them
completely during pregnancy. I took a small dose of Zoloft for
about 1.5 years while breastfeeding. It helped me, and my son
has shown no ill effects.
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
There is an excellent book available called,''Medications and
Mother's Milk'' by Dr. Thomas Hale. I am a LLL Leader and have
read passages out of the book for mothers wanting to know more
about the meds they are taking. While LLL Leaders can not give
medical advice we can give you info from this and other books.
Please feel free to email me offline or call the LLL hotline.
Melissa
June 2004
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
A little Internet research on this topic may be all the
reassurance you need about the medical implications of
SSRI's and breastfeeding. Your doctor can choose from
among SSRIs to minimize any potential effect on your baby.
If you are depressed or anxious, the decision to start an
anti-depressant may seem very difficult to make -- I would
encourage you to take your doctor's advice on this (not mine
or anyone else on the network) and see how you feel in two
months. You may find that the decision to continue or stop is
more easily made once you get out of the fog.
This is one of the trickiest parts of your life -- due to
hormones, exhaustion and the miracle that is a baby (not all
causes of stress are bad -- but all stress is hard on your
body and soul!).
Once your baby is sleeping well, you may find that diet and
exercise and having someone to take over for you on
occasion is an alternative to meds, or simply that the
situation stabilizes and you feel great. In the meantime,
your baby deserves you at your very best. If you have a
history of depression, there's no better time than right now
to stop it. You don't have to suffer to be a good mom.
I have told friends that mild depression is like twilight falling
at the end of a bright day -- sometimes you don't know how
dark its gotten, until you think to turn on a light.
Take care of you both.
One who chose Prozac, past tense.
I have taken anti-depressants for about 6 years. I was taking
wellbutrin when I told my psychiatrist that I was planning on
breastfeeding. She immediately suggested switching to Zoloft,
which has undergone more testing with regards to breastfeeding.
She used to be a pediatrician, which made me feel more secure
in her recommendation. My own research also confirmed that
Zoloft is considered quite safe for use while breastfeeding. I
take 75 mg. a day--50 in the morning and 25 at night. I take
them right after breastfeeding, which supposedly decreases the
amount transferred to baby. Almost everything that I've read
indicates that any risks posed to the infant are outweighed by
the benefits of breast milk, but certainly some would disagree.
As someone who suffered from depression throughout childhood
and early adulthood before trying meds--and who responded
immediately and profoundly to them--I wish you a similar
experience. The best thing for your baby is a happy, healthy
Mom. Good luck.
Happy New Mom
Good news. According to an article in the Mar/Apr 2002 issue of
Mothering magazine (available at local libraries), some
antidepressants, including some SSRIs, are OK for nursing because
very little medication passes through the breast milk. Others,
however, are considered unsafe. Of course, you'll need to discuss
the risks and benefits of any specific medication with your (and
your child's) doctors.
Anon.
I also suffered severe post-partum depression that was mostly
marked by intense anxiety. It was awful. And I am here to tell
you that I would not have made it t! hrough without Zoloft. Zoloft
is the one to take when you're pregnant or nursing and there are
years of data to back that up. Ask your OB about it or your
therapist (or both). Really, there is no need to suffer. You
deserve to enjoy this period of your life and you deserve to be
able to be fully present for yourself, your baby and your
partner (if you have one). I feel like Zoloft gave me my
relationships back. It made me feel like myself again. it wasn't
a false feeling--that is, I didn't feel happy about things that
were vexing--I just felt like I could cope, like I could see
what was worth worrying about and what wasn't adn I was equipped
to address the issues.
You don't mention if you're sleeping. Sleep deprivation alone is
enough to plunge you into anxiety/depression. It's CRITICAL that
you sleep. Easier said than done with a small one, but if you
can express milk or even use formula for one feeding (or two) a
night and have your partner do them so you can get 5 or more
hours of sleep it will help your mental state.
I did that, but I also had to take a sleeping pill when on
Zoloft. It was ''activiting'' for me (it's not for everyone). So
my husband took night duty with the baby which, I think, was
good for all concerned--he was pulling his weight, I was getting
a break and sleeping, I was a happy spouse, he had the foxhole
middle of the night bonding with the baby. My baby is now over a
year old and things are going wonderfully.
Good luck.
anonymous
I can't yet speak to the issue of being on an SSRI while
breastfeeding, but I am taking Prozac while pregnant right now
and plan to stay on it while I breastfeed my baby. The SSRI's
have been around long enough now that they have been studied in
pregnant and nursing moms, and the research indicates that they
may be less harmful to your baby than untreated depression.
Prozac is not the first choice during nursing--I believe that
Zoloft and Paxil are preferred. However, since I am on Prozac
already (a relatively low dose, 20 mg/day), my doctor
recommended that I just stay on it. (I have an older child and
suffered from debilitating postpartum depression after his
birth, and subsequently when I tried going off Prozac to
conceive this child.) Yes, you need to do your own research,
talk to trusted medical professionals, and wei! gh the pros and
cons for yourself, but don't be afraid to go on meds while
breastfeeding! You may be amazed at how much better motherhood
is when you are feeling more like the old self that you think
you have lost. I commend you for seeking help--and you aren't
alone!
Anon
My best friend (who will recognize me from this response!)
recently told me that I am the most relaxed she has seen me in
the twenty years she has known me, even though I am working full
time and have a six month old and two year old. She of course
knows my secret--PAXIL!!!! The post-partum and nursing hormones
aggravated my lifelong anxiety and depression to the point that
I could not stand it any more. (Like you, I tried everything to
avoid drugs.) After talking to my psychiatrist and pediatrician
I decided to try Paxil, even though it is not my first choice
drug, beca! use it is believed to be safe for nursing. (Weaning
was not an option for me either.) Both doctors believed that
the benefits for my kids of having a healthy mom outweighed any
potential risks to the baby. I take 5 milligrams a day and my
only regret is that I did not do this with baby #1! I am a
better mom, wife, employee, everything with these 5 milligrams.
I am having so much fun as a mom that I want a third already!
Life is just delightful now that I am not consumed with anxiety
and depression.
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
I had crushing post partum anxiety after the birth of my
daughter and given my family history of depression/anxiety,
decided to seek help after exercise and all my usual 'cure alls'
failed. On the advice of my much trusted ob/gyn I met with Dr.
C. Mallouh in SF who specializes in post-partem disorders. She
proscribed lorazapan which is similar to atavan (not sure of the
spelling) both anti-anxiety drugs, but my understanding is that
less of the lorazapan goes into the breast milk, so it is
preferred for breast feeding mothers. this is backed up in ''The
Nursing Mother's Companion'' which has a chapter on breastfeeding
and medications). I desperately needed help and taking the
lorazapan saved me and seemed to have no effect whatsoever on my
daughter. I took it for about 45 days at which point I weaned
off because my baby needed surgery and I was too worried about
h! er going under anesthesia with other drugs present even in
small amounts from breastmilk (no one told me it would be a
problem, I just didn't want to take the chance and wanted to
continue breast feeding). Talking with Dr. Mallouh through this
also helped. I would highly suggest seeing a specialist in post
partem disorders and that counseling go along with any
medication as I was first proscribed Prozac by my ob/gyn which
didn't help. Everyone is different and Dr. Mallouh was able to
better pinpoint the problem and suggest a solution that really
worked for me (helped me feel like my old confident self again
within a few days and that was almost 2 years ago with no
relapse). It is horrible and scary to feel so afraid and
uncertain particularly when you are caring for young children,
but I promise you it doesn't have to be that way! Dr. Mallouh
can be reached at 415.750.1713 if you'd like to set an appt with
her or ask for a ! referral to a post partem specialist in your
area.
Anon
My advice to you, go away of medications as long as you can
specially you have a child with you all time. These medications
have alot of side effect where is hard to handle the child and
his tantrum in the same time.
Yoga may help a lot specially with hormonal changes. You can
try Albany community center Yoga classes. Try to push the
medications a while longer.
Have you tried medical marijuana? I know several moms who have
used marijuana medicianlly and their children seem fine. In fact,
they seem ahead of other children their age.
Good luck with everything. I hope you get your old self back.
I am sorry that you are suffering with postpartum depression and
anxiety. I am a psychotherapist who works a great deal with
these issues. I think that for most women deciding whether or
not to try psychotropic medications is a complicated decision
and nursing brings in even more considerations. I imagine you
will receive numerous responses to your posting which will
provide a broad spectrum of experiences and responses to
medication use. This can be both helpful and possibly confusing.
Educating yourself is definitely an important aspect of feeling
comfortable with whatever decision you make. And, I believe
that weighing the possible impact of using medication against
the impact of living with depression and anxiety is important to
assess. Postpartum.net is a website from Postpartum Support
International and has various articles, resources and an on-line
forum for discussing postpartum stress issues. I'd also
recommend the organization Depression After Delivery
(depressionafterdelivery.com) for information and resources.
And, if you decide to seek assessment re: medication, I strongly
urge you to consult with a psychiatrist who is well versed in
working with the issues of nursing moms and medication. I have
spoken with numerous psychiatrists about this issue. Please
feel free to contact me if you would like appropriate
referrals.
All my best,
Lee
April 2003
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!
I had to make a similar decision not so long ago and it was hard decision for
me to make as well. It actually took me sevearal months to decide I really
wanted the medication and feel reasonably assured it would be fine for my
nursing son. I am taking Tegretol. I finally found a woman psychiatrist who I
felt was well informed and sympathetic and with her advice I took the medicine
and was glad I did. Undoubtably. being depressed and anxious contibutes to the
difficulty in making the decision. After taking the drugs I was able to share
the moment with my children, happier and more patient. anon
I can't speak to nursing but I have taken Klonopin and
antidepressants (not Effexor).
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
Anyone out there on antidepressants while breastfeeding? I took
prozac through my pregnancy but it's just not working anymore. I
also keep reading it's not the drug of choice during breastfeeding.
I stopped taking it and now 6 weeks later I'm losing my sanity, and
my poor husband. I have anxiety, moodiness, head aches, and could
cry on the spot. Help if you know anything.
I would like to know if anyone took antidepressants (SSRI) during
pregnancy (or while breastfeeding). I am not even sure if I will get
laughed out of the room if I ask a doctor. You can respond
anonymously to the advice line. Thank you so much.
I took Paxil during my pregnancy (my son was born in May '98). I
tried to quit, but I was just too depressed, so I cut down slightly --
from 50 mg to 40 mg a day. I had called the Teratogen Institute (or
something) at UC San Diego to find out what they knew. They said
that there were no human studies for Zoloft or Paxil (but I could
participate in one), but the animal studies showed no abnormalities.
Apparently the study of Prozac showed no abnormalities except that
the babies were slightly jittery.
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.
I was on an SSRI (Prozac) at the point that I became pregnant with my
daughter. Within a few days of discovering my pregnancy, I quit
taking the SSRI, cold-turkey (this is NOT recommended, but it seemed
to work out OK for me). In the process of making that decision, I
was told by several physicians (and my reading backed it up), that
the SSRIs seem to be safe in pregnancy. I chose to quit anyway,
because of the lack of data on long-term effects. But if you really
NEED that SSRI, and are in danger of hurting yourself or the baby
without it, then you should by all means TAKE it!
I hope you are able to ask your physician about this--you need to be
able to speak candidly about it, especially at this critical time in
your (and your child's!) life.
This is in regard to
taking antidepressants during pregnancy. My daughter was born on
06/11/99, I stopped taking my prozac as soon as I found out I was
pregnant, which was the day I missed my period ( 4 weeks pregnant). I
became really depressed and at about 10 weeks my Dr. checked with the
neonatal specialists in the hospital and they both agreed the benefits
outweighed the risks. So I resumed taking 20mg daily. My daughter was
born perfect as far as we can all tell. In fact her dr. says she is
advanced for her age (10 weeks). Of course I worry that some day they
will find out it causes some ailment, and Im researching breastfeeding
and antidepressants now, but, I would think being depressed would cause
more harm to your fetus than the studies have found the drugs have.
There are many anti depressants that are compatible with
breastfeeding. Two that I remember off hand are Zoloft and Paxil as
well as Prozac which you already mentioned. Many drs. are not
comfortable prescribing meds to breast feeding women because almost
every manufacturer says that the medicine shouldn't be used while
breastfeeding. That is because most of them have not done any testing
and don't want to open themselves up to a lawsuit by saying it is
safe. This goes for all types of medicines too!
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.
La Leche League will be your best friend. There is a wonderful woman
by the name of Lyla in Oakland who listened to me, helped me and made me
feel comfortable when I needed to be heard very badly. She has loads of
information and doctors the she can refer you to. From what I understand,
zoloft is preferred over prozac while breastfeeding (although I dont have
any personal experience with it). I have never met her in person but her
name is Lyla (sp?). Good luck
to you, and remember that being depressed is NOTHING to be ashamed of
and it is NOT as character flaw. It is a condition like any other
medical condition. Best of luck.
I wanted to offer some resources to the woman inquiring about
medication and breastfeeding and to all women who may be experiencing
postpartum depression or anxiety which can develop up through 18 months.
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
I think I can help with your problem of not feeling like the Prozac is
helping. I had an internist subscribe prozac and give me the standard
dosage. She had me check in after 3 months. Whereas recently, I have
gone to a psychiatrist who monitors me weekly until we get the dosage
correct. I was always worried about the stigma of going higher than
20 mg for prozac, but he explained to me everyone absorbs prozac
differently and that you have to adjust for metabolism... Well, since
my metabolism is extremely high from breastfeeding we had to
significantly raise my dosage. So, my advice is to work closer with
your doctor or find one that monitors you more closely. You probably
only need to increase your dosage temporarily. Believe me it makes the
world of difference!!
For the person who asked about Prozac and nursing: I asked a similar
question a few years ago when I sure could have used some prozac. I had
gone off for the pregnancy and nursing. There were no good answers out
there, but Layla from the
Oakland La Leche League was so very helpful and knowledgable that I would
track her down again. She also referred me to a doctor out of the area
that has done alot of research on this topic. When I contacted him (all I
know is that he called himself Dr. Tom) he told me that zoloft was better
than prozac if the baby is very young. My doctor thought it would be best
NOT to use it while nursing. I decided to wait it out 13 months till
weaning my baby to start. I dont know if I would do that again. I was
adamant about nursing but looking back, the untreated depression nearly
destroyed my marriage and made me a
miserable (still very caring) mom. I hope there are better answers out
there today than 2 years ago. Good luck.
Although I don't have personal experience, there is a big book called
something like Medications in Breast Milk which is what lactation nurses
refer to when a medicine for the mother is called for. In my experience,
doctors don't have access to this book, they just look up the medication
in their little pocket PDR guide and it will say not tested on nursing
women
or some such thing. Get in touch with a lactation nurse and they will
look up the medication for you, and discuss it. There are other factors
as well, like how much you nurse your baby, how much other
food/milk/formula he or she eats, etc which sometimes make the difference
in whether you should start a medication which is not absolutely
manditory for your health. Good luck, keep nursing.
Elizabeth
I feel I need to share my experience with post-partum depression. I had it
bad in 1995 after the birth of my child. I also had post traumatic stress
syndrome from the birth experience. It was very difficult and got
life-threatening, long story. What helped my recovery at the time was nursing
and counseling. I am alarmed at the number of mothers out there who
are being told to wean their babies and go on medication. It breaks my heart.
For me, breastfeeding was my medication. It soothed me and kept me bonded
with my baby. I also went to a therapist to talk and I joined a new mom's
support group. My depression continued for a couple of years and I eventually
started therapy with Linea Larsen who also does EMDR therapy. This helped a lot and after awhile I was ready to get
pregnant again. My second child is due in August. I know that there are
different levels of depression, and medication is needed and helps many, but
I would hope that mother's doctors would do more to preserve the nursing
relationship first.
There is an outpatient clinic at Langley Porter at UCSF that
specifically does referral work, evaluations and follow-ups for
medications such as anti-depressants. I don't have the phone number
but it is, I believe, run by Dr. Owen Wolkowitz. It happens he is a
good friend of mine, and there is an article in HEALTH magazine April
2000 issue, largely about the psychopharmacology research he (and
others) are doing on stress and depression.
Peggy
Prozac is one of those antidepressants that's probably safe for breast-feeding
mom's to use but it's not the best choice out there. Dr. Hale (author of
Medication and Mothers Milk) recommends that Paxil or Zoloft be used
instead *if they work for the mom* because they are safer. But if those others
are not a choice, then Prozac is considered by most breast feeding-friendly
doctors to be better than weaning. The key is careful
monitoring of the baby for changes in behavior. (But heck, you should do that
whenever you take any drug.)
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 is some info about Paxil if you want to look at that as an alternative: As
for Paxil, Dr. Hale considers it the best of that class of drug for bfing moms.
The entry in Hale's says that it spreads throughout the body well with only 1%
remaining in plasma and that in studies of bfing moms, the amount in the milk
was .34% of the maternal dose (1/3 of what was in the bloodstream).
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.
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