Which Psychiatric Medications Are Safe During Breastfeeding?

Which Psychiatric Medications Are Safe During Breastfeeding -postpartumprogress.com

I’m often asked by mothers who want to breastfeed about which psychiatric medication is safe.

First, I want you to know that it is a myth that you must quit breastfeeding if you are going to be treated for postpartum depression. I’m always saddened to hear of moms who refuse to seek treatment because they are afraid they will be made to quit, or whose doctors tell them they must because they’ll be on medication. That’s just not true.

Certainly, if you feel that it is better for you to formula feed that is a perfectly acceptable choice. Also, therapy alone is a good option for some mothers. If you need to take medication, though, you still don’t have to quit. There are certain medications that have been well studied and, according to the MGH Center for Women’s Mental Health, are “… considered to be relatively safe for use during breastfeeding when clinically warranted …”

I wanted to offer you some resources for those of you who plan to breastfeed but must also take an antidepressant or other psychiatric medication for the treatment of your postpartum depression or related illness.

Breastfeeding and Medication from Massachusetts Center for Women’s Mental Health

Other Resources for Breastfeeding Moms

InfantRisk: Antidepressant Use During Pregnancy & Breastfeeding | Note: Infant Risk now has an app!


OTIS Fact Sheets:

Note: The OTIS fact sheets have primarily information on taking these medications during pregnancy, but they address their use during breastfeeding toward the end of each fact sheet.

Also, when you read resources written by clinicians, you may notice they do not use the marketing or brand name of the drug but the clinical name, so I’m giving you a little glossary here so you’ll know to which medication they are referring:

fluoxetine = Prozac
sertraline = Zoloft
citalopram = Celexa
paroxetine = Paxil
venlafexine = Effexor
buproprion = Wellbutrin
escitalopram = Lexapro
lamotrigine = Lamictal

Why Americans Don’t Want To Discuss Depression With Their Doctors

postpartum depression diagnosis and treatmentA fascinating new study finds that a large chunk of Americans would rather not discuss symptoms of depression with their doctors.

According to Health.com, “43% of people would keep their depression symptoms to themselves during a doctor’s appointment, because they feel their emotional difficulties are off-topic, they don’t want to be prescribed antidepressants, or they’re afraid a record of the conversation will be seen by employers … Respondents also expressed fear about being referred to a specialist or being labeled a ‘psychiatric patient’.”

[Read more…]

Is Your Antidepressant Working?

I often think the stories on depression, and particularly postpartum depression, are lacking on popular medical and health websites. Usually a lot of fluff and not much that really helps. I actually think this brief slideshow from WebMD, however, is pretty good: Is Your Antidepressant Working?

Check it out for good tips on what to expect, and on how and when to talk to your doctor about side effects or the effectiveness of your treatment plan.

Brace Yourselves: ParentDish Covers Antidepressants During Pregnancy

So a while back I heard from Julie Rosenberg, a writer for ParentDish who was doing a story on PPD. Honestly it's hard to remember when it was, and I'm not trying to be a butthead when I say that, it's just that I already have no memorywhatsoever.

Recently she emailed again asking me for a pic for the story and I said sure no problem and sent one of me with my gorgeous boy. Yes, that boy.

Then I saw the story came out today and it was ALL about using antidepressants during pregnancy. I didn't remember that being the focus, though I'm sure it was … I had just forgotten. And I thought to myself, "Oh goodness, here we go." Brace yourselves.

The story is actually very balanced, but I can see howthose with preconceived notions will think I'm promoting taking antidepressants during pregnancy. I can see how some of the quotes from mothers who did choose to take psych meds during pregnancycould be misconstrued by some as though these womenwere all happy-go-lucky about the decision. As if it was an easy decision to make.

I can't say anything about antidepressants without being accused of pushing them. Or selling them. Or being addicted to them. Or some other such claim. I do take one for my OCD/anxiety and am not ashamed of that in any way whatsoever. NOT ASHAMED, EMBARRASSED, or any other kind of stigma someone would like me to accept but that I will refuse to.

I did take meds when I had postpartum OCD, but I also went to therapy, so I can't tell you whether one was more responsible than the other for my recovery — or maybe both equally so. I think if you need medication and it works for you, good.It works for me. If you do something else that works for you, good too. Do what is right for you. But now that I've been quoted inParentDish's article on taking medication during pregnancy, I'm sure none of whatI just said will have any bearing on how certain people will respond.

It was anerve-wracking decision for me to make, to continue with my antidepressant when I was pregnant with my daughter.There are always risks when you are pregnant, with taking anything at all. There are also risks — onesof which many people are unaware — that can come with suffering from clinical depression or anxiety while pregnant. When you face a risk no matter what you do,you just have to come to accept that and make a choice. I made the choice to take meds based on the research available to me at the time, and on the fact that I didn't want my daughter swimming in anxiety inside my belly, and that I didn't want my family to suffer if I had postpartum OCD again which was likely.I chose to put the oxygen mask on myself first.Considering the positive outcome, it feels like in the end it was the right choice for me.

Sadly, there isn't enough research to make it easy for people to make a risk-free decision. There is a huge relapse rate for women who've suffered previous mental illness who go off their meds during pregnancy. There are also studies that show that babies can be negatively affected when women take antidepressants and then to make things even more confusing, there are studies that refute those studies and state that the risks to babies are minute. It's hard to navigate through it all.

I'm grateful that researchers who care about this issue are looking into as many avenues as possible fortreatments of mental illness during pregnancy, including light therapy and acupuncture. I'm grateful to the ones that are continuing to look closer at the effect –or lack thereof, whichever the case may be — of psychiatric medication on infants. I am also grateful to organizations like ACOG that realize there is no cut-and-dry answerand offer guidelines to doctors who are often uninformed about the spectrum of risk.

I hope one day it will be easier for those of us with mental illnesses like PPD to makethese kinds of decisions without worry. That will be a great day indeed. As for now, I'm comfortable with the decision I made and I hope that every other mother has as much information as possible and is supported in the decision she makes, whatever it is.

Itwill be interesting to see what kind of comments Julie's story gets. Hope you'll join the discussion.

Update: Strollerderby on Babble.com has weighed in on the topic now as well.

Also, click here for more stories on pregnancy and depression.