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Thread: antidepressants and breastfeeding

  1. #1
    Join Date
    Jul 2007

    Default antidepressants and breastfeeding

    I get major postpartum depression. This is my 3rd (and last) child. My doctor told me that things have changed from the last baby (almost 4 years ago) and that research has proven that it is fine to take most antidepressants while breastfeeding. He said the only side effect really known is sleepy babies but nothing else. Anyone else heard anything on this subject? Last time I was pregnant they didn't allow medication while breastfeeding and I was able to do it 3 weeks before I was about to have a breakdown. It was horrible and I dont want my husband or family to go through that again. I figured that breastfeeding a sleepy baby is better than not at all.
    Thank you

  2. #2
    Join Date
    Jun 2006
    Not around here as much :(

    Default Re: antidepressants and breastfeeding

    Yes - they are finding that many meds are safe with babies. If you have a local LLL leader that you can call she should be able to talk to you more about it... heres one page that covers some links about it. And another here And a medication specific on here. There's many more out there but that should be sufficient to start you out!

    good luck! and happy nursing!!!!!
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  3. #3
    Join Date
    Jan 2006

    Default Re: antidepressants and breastfeeding

    This resource is a good starting place for your research:

    There is MUCH more information out there (the above is a great overview of the general info).

    Other resources:
    Medications and Mothers' Milk (2006 version), Hale
    Lactmed database
    Dr. Hale's medications forum

  4. #4
    Join Date
    Apr 2007

    Default Re: antidepressants and breastfeeding

    Yes, you can nurse while on AD's. I had PPD with my second and after trying to deal with it on my own and thinking it would go away (it got worse) they put me on Lexapro. It's very good and had no side effects at all. DD is a very happy baby and isn't sleepy at all. We are almost 9 months into exclusive nursing and I've been on the medication since she was almost almost 2 months old and it worked wonders for me. I am much clearer headed and even though I get a little blue some day's, it's nothing like what I was struggling with the PPD. I am going to stay on it a little longer to make sure my hormones are more leveled out!

    Good luck and I hope you find a medication that is right for you!

  5. #5
    Join Date
    Jul 2007

    Default Re: antidepressants and breastfeeding

    Thank you all for the resources and the stories. I feel so much better and optimistic. I am especially grateful to know that someone has been on the Lexapro and everything has turned out ok.
    Lorayne Gothard

  6. #6
    Join Date
    May 2007

    Default Re: antidepressants and breastfeeding

    Like you, I've suffered from ppd with each of my 3 children. I am currently taking Zoloft and was worried about the effects, too. But I know how I feel when I'm not on meds (I tried to fight the ppd, unsuccessfully, with my firstborn and I was a nightmare to live with!). Luckily my LO is normal as far as the sleepiness goes and doesn't seem to be suffering any ill effects from my meds. I agree that bf'ing a sleepy baby is better than not bf'ing at all. I worry more about withdrawal when she either stops nursing or if I no longer need meds.

  7. #7
    Join Date
    Jul 2007

    Default Re: antidepressants and breastfeeding

    Hello Becki
    I just got a response from the La Leche League and Lactating consultants and they recommend Zoloft above all other medications at this time. They did a lot of reseach on the drug and because of the half life it doesn't hardly affect the milk at all. The thing I need to find out is how long it takes for it to build up in your system. Lexapro was great because you feel a difference within a couple of days (I had panic attacks too so I needed it to work fast). Can you tell me how long it took for the Zoloft. I am going to post the response for you from LLL in case anyone can benefit from it. Lorayne


    Thank you for sending your question to La Leche League. I hope the information I'm sending will be of some help to you. When you have a chance, could you let me know you received this message? Thank you! Please also feel free to write back if you need more support or information.

    It is important to treat your depression, and the sooner the better. It's also important to babies' development that mothers get treatment when they are depressed.

    Your doctor may be familiar with the resource Medications and Mothers' Milk, by Thomas Hale, PhD. That is the resource that La Leche League Leaders use to find information about medications and breastfeeding. La Leche League Leaders are volunteers with breastfeeding experience and training about breastfeeding. We are not physicians. We can't advise mothers about what medications to use, but we can provide information about a specific medication. Please discuss all of this information with your doctor as you work on selecting the best medication for you.

    I'd like to give you some general information about the use of medications during breastfeeding.

    Most medications (but not all) are compatible with breastfeeding. Here is an article written by Dr. Thomas Hale (an expert on this subject) about the use of medications during breastfeeding:But Is It Safe for My Baby? Medications and Breastfeeding
    by Thomas W. Hale
    Issue 111 March/April 2002


    Anti depressants:

    If you are talking to your doctor about anti depressants, ask him about which SSRI he recommends. The three most popular that have been around for a while, and have been studied the most,are Prozac, Zoloft, and Paxil. An important factor to consider is the half-life of the drug. A drug with a shorter half life is generally better for a breastfeeding mom because it is eliminated from the blood stream and therefore the milk more quickly.

    Of these three, Zoloft has the shortest half life. (Prozac has a very long half life and should be avoided if Zoloft or Paxil will work.) Here is a quote from that article I sent you a link to above:

    "The use of Zoloft, on the other hand, has been reported in more than 30 breastfed infants, and appears to transfer poorly to the infant and with no reported effects.18,19 Thus far plasma levels in most infants have been close to or below the limit of detection, with no reports of untoward effects in the infant. At this time, Zoloft is probably the SSRI of choice for nursing mothers. Several reports of Paxil use suggest that its levels in breastmilk are exceedingly low, and the amount transferred to the infant would be minimal."

    Many medications transfer through breast milk in amounts that are too small to affect the baby, typically about 1% or 2% of the mother's dose. Some medications do not pass into the milk at all. Some medications are poorly absorbed through the gut, so that even if they do pass into the milk, the baby is not affected by the medication.

    When considering whether to take a medication, it's important to consider the known benefits to the baby of breastfeeding, as well as any potential risks of the medication. We know that breastfeeding provides the best nutrition, protects babies against illness, protects against long-term health problems, and helps mother and baby to have a close, loving relationship. There are so many benefits of breastfeeding that it's impossible to list them all. There is a lot to consider in making the decision about using a medication during breastfeeding, and it's good to talk to your doctor about all the aspects of it.

    I will give you information on breastfeeding with Lexapro. The following information comes from MEDICATIONS AND MOTHERS’ MILK by Thomas Hale, 2006. He assigns every drug a lactation risk category: L1, safest; L2, safer; L3, moderately safe; L4, possible hazardous; and L5, contraindicated. He also lists if a drug has been reviewed and/or approved by the American Academy of Pediatrics (AAP) for use in nursing mothers. Possible risks to mother and baby are listed as well as possible effect on milk supply and suggested alternatives.

    L3 in older infants, caution in using with newborns; not reviewed by the AAP; Pediatric concerns: The manufacturer reports several cases of somnolence (excessive sleepiness) in newborn infants using citalopram (Lexapro is identical in ingredients to the drug citalopram). The author has received numerous similar reports with Lexapro specifically. Caution is recommended in newborn or young infants.

    Suggested alternatives (with the trade name and the lactation risk category for each): Sertraline (Zoloft L2), Paroxetine (Paxil, L2); bupropion (Wellbutrin L3); venlafaxine (Effexor L3)

    Some recent research suggests that breastfeeding protects babies against some of the negative effects of mothers' depression. Here is an article that discusses some of this research: http://www.lalecheleague.org/ba/May05.html

    It is definitely possible to treat postpartum depression while continuing to breastfeed. It's important to stay in communication with your doctor about these issues. If you communicate to your doctor that breastfeeding is important to you and your baby, and that you want to treat your postpartum depression in a way that is safe for your baby while preserving breastfeeding, he or she should be able to work with you to find treatments that you feel comfortable with.

    Kathy Kendall-Tackett has written two wonderful books that you might find helpful: The Hidden Feelings of Motherhood and Depression in New Mothers. These books include so many useful tools for dealing with the dark side of mothering. They may be available from the LLLI Online Store, at http://store.llli.org, or you might be able to find them at your local library or bookstore.

    Here are some things that have helped many mothers. Some mothers have used these in combination with anti-depressant medication, while others have found that by using these they don't need medication:

    cognitive-behavioral therapy
    exercise and a healthy diet
    alternative therapies

    I hope that considering these issues helps with your decision. Please let me know if you have any other questions or need more information.

    La Leche League's manual THE WOMANLY ART OF BREASTFEEDING has lots of good information on breastfeeding your baby. You can buy it through our Online Store at:
    http://store.llli.org. You may also find it in bookstores or libraries in your area. It has been through six revisions and contains all the latest research-based information available about breastfeeding.

    Perhaps it would be helpful for you to call a Leader in your area or attend a La Leche League meeting. The support and information of other nursing mothers may prove helpful to you. Check out the section of our Web site entitled "La Leche League Groups Around the World" at http://www.llli.org/WebIndex.html

    Teglene, LLL Leader, Arnold, CA

  8. #8
    Join Date
    May 2007

    Default Re: antidepressants and breastfeeding

    Hi Lorayne,
    I took Lexapro after two of my three children were born. This time, because I had planned to bf, my doctor recommended the Zoloft. I started taking the Zoloft about 2 days after I gave birth. I thought it worked as quickly as the Lexapro did in my previous usage (at least in my case). I suffer from major anxiety along with ppd and used to take Lexapro and Xanax combined. So far (I'm in my third month postpartum) I haven't needed the Xanax. Zoloft has been a saviour for me! I only take 50 mg (which is a low dosage for Zoloft) compared to the 40 mg's of Lexapro that I used to take (which, according to my doctor, was on the high end of dosages for Lexapro).
    Thank you for posting that info. Please let me know how you are doing. And best of luck to you!!!

  9. #9
    Join Date
    Jul 2007

    Default Re: antidepressants and breastfeeding

    Thank you Becki. You have inspired me to take the Zoloft. Sounds like you and I have similar depression. I have 30 days till the c-section so I am counting down!!! I am so glad the Zoloft helped you. I will tell my doctor to start me out at the same dosage you are taking. It is comforting to know that it helped with the anxiety too. It isn't bad enough you get super bad pp depression but then you have anxiety on top of it. Good luck with your little baby!!!

    By the way I love your little pictures!! Does that mean you have one sleeping with you and one breastfeeding?? We have a 10 year old boy (Brandon) that sleeps in his own room now, a 3 year old girl (Zoe Alexandra) that is still in the bed with us, and a little girl on the way (Mia Elizabeth) that will be in the crib next to us. We are big on letting the kids move into their own rooms when they are comfortable (even though my husband wishes they would make the transition sooner..lol). Anyway, I guess that is another topic entirely. Wanted you to know I liked the pictures!!!
    Last edited by lgothard; July 31st, 2007 at 11:28 PM. Reason: Add something I didn't see before

  10. #10
    Join Date
    Aug 2006

    Default Re: antidepressants and breastfeeding

    I've had PPD with each of my three children and then in between my first and second child I also had major depression which put me in the hospital. With my first child, I didn't have any meds given to me because they weren't sure of the safety as I was breastfeeding. That was 11 years ago though. Shortly before I got pregnant with my second child (a little over 2 years ago) I was hospitalized for depression. I went through Paxil, Prozac, and Trazedone...all of which stopped working. They put me on Zoloft and shortly afterward I had gotten pregnant. At the time, Zoloft was considered a category c medication (all that means is that they hadn't tested it on pregnant women due to ethics and it caused deformities/deaths in animal fetuses when taken in massive quantities). The doctor was a little iffy on it, but felt the risk to me not being on it was greater than the risk of my taking it. My DD was perfectly healthy in every way at birth. I continued to take it while I nursed her until I no longer needed it about six to nine months after she was born. There weren't any withdrawal symptoms for either of us when I stopped because I was weaned off of it. I did just recently start taking it again to deal with PPD again. So far there have been no side effects for my DS. He's been quiet and alert since birth and that has not changed. He's not fussy or anything else. He's got a very hearty appetite which has increased since he turned 3-1/2 months old.

    Zoloft, Paxil, Prozac and Trazedone all take about thirty days to get into your system and start working. They have to build up for you to get the effects. At least that's what my doc has said.
    Wife to Brandon since 10/14/2003
    Mommy to Erin, my know-it-all preteen, since 7/03/1996.
    Mommy to Katrina, my adventurous toddler, since 7/29/2005.
    Mommy to Connor, my "little man," since 4/22/2007.

    Life can be hectic, but I wouldn't change it for the world.

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