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will i be able to bf?(edit)

Posted by on Jan. 14, 2013 at 3:59 PM
  • 15 Replies
Im having my baby thursday.I have been off my celexa the entire time i have been pregnant but i NEED to get back on it.I cant stand myself idk how other people have been able to.my question is can i bf and be on celexa?i am going to my ob tomorrow and i will ask there but this is really bothering me and i have seen several people say not to listen to the doctor so i am asking you ladies.please dont bash me.(EDIT) thank you ladies i think after reading everything i will talk to my doctor about trying other things.
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by on Jan. 14, 2013 at 3:59 PM
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TattoodMommy19
by on Jan. 14, 2013 at 4:06 PM
What mg please?
I'll look it up for you.
I'm on zoloft and it is perfectly safe.
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merinasmommy
by on Jan. 14, 2013 at 4:09 PM
i dont remember what i was on before.it was almost the lowest though.


Quoting TattoodMommy19:

What mg please?

I'll look it up for you.

I'm on zoloft and it is perfectly safe.

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missyice
by on Jan. 14, 2013 at 4:16 PM
It can be so hard to know with medication! I am on tablets for high blood pressure. One of the warnings on the packet says not to use while breastfeeding! This medication was perscribed for me while at the hospital, after just having had my daughter, and while breastfeeding. Maybe get a few different opinions on what is safe while breastfeeding.
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merinasmommy
by on Jan. 14, 2013 at 4:24 PM
ive tried looking it up and it seems like every website says something different.its so confusing


Quoting missyice:

It can be so hard to know with medication! I am on tablets for high blood pressure. One of the warnings on the packet says not to use while breastfeeding! This medication was perscribed for me while at the hospital, after just having had my daughter, and while breastfeeding. Maybe get a few different opinions on what is safe while breastfeeding.

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luna321
by Bronze Member on Jan. 14, 2013 at 4:26 PM

Here is what I found on Kelly Mom- 

http://kellymom.com/bf/can-i-breastfeed/meds/antidepressant-ref/

Using Antidepressants in Breastfeeding Mothers

July 28, 2011. Posted in: Medications & Vaccines

Keynote address by Thomas Hale, PhD
LLL of Illinois Area Conference, Bloomingdale, IL
October 26, 2002

Attendee’s report by Eva Lyford

Reviewed and edited by Thomas Hale, PhD

published at kellymom.com with permission from Eva Lyford and Thomas Hale, PhD

Dr. Hale provided an insightful and fact filled presentation on treating depression in nursing moms. For reference on items contained below, see Medications & Mothers’ Milk, 2004 by Thomas Hale. Notes are arranged as follows:

  • Drug Hierarchy
  • Concluding remarks
  • Highlights

    Highlights were that:

    • The effects of an untreated depressed mom on the infant are significant and hazardous; but the marginal effects of any medication usually are less hazardous than those effects. Treating a mom with postpartum depression (PPD) is much preferable to not treating, since a baby has a better outcome generally (as measured by Bayley scores, measuring interaction skills and speech and language development) when being cared for by a non-depressed parent.
    • PPD is significantly more dangerous compared to depression outside of postpartum; PPD patients are sometimes more likely to commit suicide, and need to be treated with due haste. Waiting to wean before starting medication is not a sound option. Also, weaning in order to treat is not a good choice due to the loss of the positive effects of breastfeeding. The rate of depression in the general population in an individual’s lifetime is between 3% and 17%. However, in the postpartum population depression is about 15%, and is often more severe. For example, it moves to psychosis more frequently.
    • In all studies thus far, any negative effects of medication usually occur in the first 30-60 days postpartum, so breastfeeding beyond that and taking medication is usually fine.
    • Babies exposed in utero can suffer “discontinuation syndrome” (a.k.a. withdrawal effects) but sometimes this is misdiagnosed as a reaction to the continued medications in mom’s milk, when really the milk transfer rate for many of the SSRIs is negligible.

    SSRI improvements over older drugs

    The SSRI family of antidepressants is significantly improved over older antidepressants as follows:

    • Not addictive
    • No associated buzz
    • Mild withdrawal or “discontinuation syndrome” in some patients
    • More rapid onset as compared to older tricyclics
    • Side effects generally wane over time
    • Reported 60%-70% response rate in patients.

    SSRI sequence of effects

    The sequence of effects for SSRIs is as follows:

    • Sleep and anxiety normalize within the 1st week
    • Motivation, interest, hopefulness and appetite return within 2nd and 3rd week
    • Mood and libido may improve after (libido may worsen)

    Specific drugs

    Specific drugs discussed:

    • Prozac is the only drug “cleared by the FDA” for use during pregnancy. A mother on Prozac during pregnancy may wish to change drugs before birth or immediately after, or titrate the dose down in the last trimester since the existing blood plasma level in the newborn fetus plus the drug transfer through milk may lead to toxicity. Its effects on the breastfed infant have been reported in infants 2 months old or less.
    • Zoloft is the “best drug choice so far”. It has a low, low transfer rate to breastmilk (17-173 ug/liter) in mothers taking up to 150 mg/day. In one excellent study of 11 mother/infant pairs, the zoloft was undetectable in 7 of the 11 breastfeeding infants’ serum and minimal in the other infants. In two other studies of one and three mother/infant pairs respectively, zoloft was undetectable in the plasma of all 4 infants. A theoretical concern with Zoloft is that some babies may not gain weight as rapidly or as well when breastfed by moms on Zoloft; so weight gain should be monitored and dosage tweaked as necessary.
    • Paxil has low blood plasma levels in the mother, and a low transfer rate to human milk. It was undetected in the blood plasma of 7 of 8 breastfed infants in one study, all 16 of the infants in a second study, and all 24 of the infants in a third study. For babies exposed to paxil in utero, there is evidence that withdrawal may occur 24-48 hours after birth.
    • Celexa has a 4.3-16 nanogram/kg blood plasma level, but transfer rate is higher via milk. Use with caution and watch infant for side effects (per Hale, “There have been two cases of excessive somnolence, decreased feeding, and weight loss in breastfed infants.”).
    • Effexor is a popular drug for treating depression in Australia. It is less popular here in the USA due to reported side effects. Effexor can also be used in breastfeeding mothers if it is efficacious. It may be effective against hyperactivity. It is an SSRI and NRI.
    • St. John’s Wort is a weak SSRI. It also stimulates liver enzymes and may enhance the metabolism of other drugs. German varieties are found to be the most pure in independent testing; other brands may have contaminates and not be very pure. Documented drug-drug interactions have been found; the action of St. John’s Wort on the liver can accentuate the metabolism of many drugs. For example, St. John’s Wort may reduce the efficacy of birth control pill regimens, although this has not been documented.
    • Bupropion has a high milk to plasma ratio, and is excellent for use in smoking cessation programs. It may reduce the milk supply but as yet this is undocumented.
    • Lithium use by the breastfeeding mother is dangerous to the breastfed infant.
    • Valium use by the breastfeeding mother entails a greater risk of infant sedation, and may perhaps increase the risk of SIDS.
    • Tricyclics – many have significant side effects in mothers including dry mouth, constipation and other anticholinergic symptoms. Thus they are not overly popular with patients. Generally, tricyclics have a poor transfer to milk with the exception of Doxepin, which has a higher transfer rate. Long-term effects are unknown.

    Drug Hierarchy

    When choosing a medication SSRIs are generally the preferred choice for a breastfeeding mother. Side effects from SSRIs are most common in the first 3 months postpartum; so with an older baby, there is little concern. Hale’s “choice hierarchy” is as follows:

    • Zoloft
    • Paxil
    • Celexa
    • Effexor
    • Prozac

    Concluding remarks

    Finally, Dr. Hale concluded his talk by saying that breastfeeding should be supported fully and not interrupted by mom’s needs for medication; and that treatment of postpartum depression can be accomplished relatively safely in breastfeeding mothers. So, in his consideration, moms should continue breastfeeding and should get drug treatment as needed for depression.

    LoveMyCuties612
    by on Jan. 14, 2013 at 4:30 PM
    I was on celexa as well! Oh God did.it help me. I have been a beast while off of it but when.I looked it up on kellymom.com it said with that particular antidepressant it leaves traces in breastmilk. It didn't way that it will harm baby, but for me I was too scared to go back on it. I guess if u know yourself well enough to know that the benefit of you taking it outweighs the possible effects of it on the baby then I'd take it. I remember reading that it can make babies more sleepy. I'm not sure. I hope someone can give u more feedback! I've considered going back on it MANY times but I'm too weary :/
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    MonicaV1982
    by Gold Member on Jan. 14, 2013 at 4:33 PM

    From Lactmed:

    Drug Levels and Effects:


    Summary of Use during Lactation:
    Infants receive citalopram in breastmilk and it is detectable in low levels in the serum of some. The dosage that the infant receives and serum level achieved are probably related to the genetic metabolic capacity of the mother and infant. A few cases of minor behavioral side effects such as drowsiness or fussiness have been reported, but no adverse effects on development have been found in infants followed for up to a year.

    If citalopram is required by the mother, it is not a reason to discontinue breastfeeding. If the mother was taking citalopram during pregnancy or if other antidepressants have been ineffective, most experts recommend against changing medications during breastfeeding. Otherwise, agents with lower excretion into breastmilk may be preferred, especially while nursing a newborn or preterm infant. The S-isomer of citalopram, escitalopram, has a usual dosage of escitalopram of about 25% that of citalopram, infant exposure is lower, and adverse reactions appear less likely. Escitalopram therefore may be preferred over citalopram during breastfeeding. The breastfed infant should be monitored for behavioral side effects such as sedation or fussiness. Mothers taking an SSRI during pregnancy and postpartum may have more difficulty breastfeeding and may need additional breastfeeding support.


    Drug Levels:
    Citalopram is metabolized to 2 metabolites, each having antidepressant activity considered to be 13% that of citalopram.[1]

    Maternal Levels In a pooled analysis of serum levels from published studies and 2 unpublished cases, the authors found that 18 mothers taking an average daily dosage of 29 mg (range 20 to 60 mg) had an average milk citalopram level of 157 mcg/L (range 41 to 451 mcg/L).[1] Using the average dosage and milk level data from this paper, an exclusively breastfed infant would receive an estimated 7.9% of the maternal weight-adjusted dosage of citalopram.

    In 9 mothers taking citalopram 20 to 40 mg daily while breastfeeding, trough milk samples were taken immediately before nursing on the morning of day 4, and during week 2 and month 2 postpartum. Citalopram milk trough concentrations standardized to a dosage of 20 mg daily averaged 81.4, 103.4 and 75.9 mcg/L at the 3 sampling times. The authors reported that an exclusively breastfed infant would receive an estimated minimum of 0.3 and 0.2 % of the maternal weight-adjusted dosage of citalopram at 2 weeks and 2 months postpartum, respectively.[2] However, these values appear to be the result of a calculation error. Using the milk concentration values above, one can calculate a minimum infant dosage of 4.7 and 3.4% of the weight-adjusted maternal dosage which is consistent with values reported in other studies.

    In 10 breastfed (extent not stated) infants (including one pair of twins) aged 3 to 42 weeks whose mothers were taking an average daily dosage of 24 mg (range 20 to 50 mg) of citalopram, the authors calculated that their fully breastfed infants would receive an average of 5.2% (range 2.5 to 9.4%) of the maternal dosage.[3]

    A mother was taking oral citalopram 40 mg once daily in the evening. Single milk samples were obtained 16 hours after the dose on days 25, 46 and 53 postpartum. Milk citalopram levels were 280, 230 and 320 mcg/L. These values represent 5.8%, 4.7% and 6.6% of the maternal weight-adjusted dosage.[4]

    Infant Levels In a pooled analysis of 5 mother-infant pairs from published and unpublished cases, the authors found that infants had an average of 7% of their mothers' citalopram plasma levels; 1 of the 5 infants had a plasma level greater than 10% of the mother's plasma level which was defined by the authors as being elevated.[1]

    The breastfed infants of 9 mothers who took citalopram during pregnancy and postpartum had serum citalopram levels that were 63% of maternal serum levels at delivery. The infants' serum levels fell by 37% by day 2, 61% by day 4, and 90% by week 2, despite exclusive breastfeeding. At 2 months of age, infant citalopram serum levels were about 2% of those of the mother; metabolite serum levels were somewhat higher.[2]

    In 10 breastfed (extent not stated) infants aged 3 to 42 weeks whose mothers were taking citalopram in an average daily dosage of 24 mg (range 20 to 50 mg), citalopram was detected in 6 of the infants. The serum drug levels of the 10 infants averaged 0.9% (range 0 to 4.8%) of those of their mothers. Two of the infants with detectable citalopram were twins whose mother was a poor metabolizer of citalopram (CYP2C19*2 mutation). Five infants with the CYP2C19*1/*2 genotype had serum levels that were 3.75 times higher than the other 5 infants with the CYP2C19*1/*1 genotype.[3]

    A mother was taking oral citalopram 40 mg once daily at 11 pm. Infant serum levels were measured at 12, 25 and 53 days of age, the first at an unspecified time and the latter two at 3 pm. Infant citalopram serum levels were 2.3, 1.2 and 1.7 mcg/L at these times. The infant serum levels on days 25 and 53 represented 0.9% and 1.8% of the mothers serum levels, respectively.[4]


    Effects in Breastfed Infants:
    The manufacturer states that drowsiness and weight loss in breastfed infants has occurred.

    Uneasy sleep that reversed with dosage reduction and partial formula supplementation was probably caused by citalopram in breastmilk in a 5-month-old infant.[5]

    A group of 10 infants breastfed (6 exclusive, 3 received some formula beginning at 2 months) from birth to one year during maternal citalopram use had normal body weight and neurological development in all infants compared to 9 control infants whose mothers did not take citalopram.[2]

    Three mothers who took an average citalopram dose of 15 mg once daily breastfed their infants exclusively for 4 months and at least 50% during months 5 and 6. Their infants had 6-month weight gains that were normal according to national growth standards.[6]

    A study compared adverse reactions in 31 infants breastfed during maternal citalopram use to a control group of 31 breastfed infants whose mothers did not take an antidepressant. There were numerically more adverse events reported in the citalopram group (3 vs 1). However, the study found no statistical difference in the rate of adverse effects between the groups of infants and none of the side effects was serious. One mother reported infant irritability and restlessness after she began citalopram at 2 months postpartum. The side effects subsided after she stopped breastfeeding 2 weeks later.[7]

    In 10 breastfed (extent not stated) infants aged 3 to 42 weeks whose mothers were taking citalopram an average of 24 mg daily, no short-term adverse reactions were noted clinically at the time of the study.[3]

    A breastfed infant whose mother took citalopram 40 mg daily throughout pregnancy and postpartum had numerous symptoms such as superficial and irregular breathing, apnea, disordered sleep and hypotonia after birth. All symptoms disappeared by 3 weeks of age. Symptoms were judged to likely be withdrawal symptoms rather than side effects of the drug in the breastmilk.[4]

    A woman was restarted on citalopram 10 mg daily after having stopped the drug for the last month of pregnancy. Her infant breastfed for 6 months (extent not stated). The infant had no perinatal complications, and the infant's pediatrician noted no neuropsychological abnormalities at 18 months of age.[8]

    A woman took citalopram 60 mg and ziprasidone 40 mg daily throughout pregnancy and postpartum. She breastfed extensively, except for occasional formula feedings by others. At 6 months of age, a pediatrician found the infant to be healthy with normal growth and development.[9]

    An uncontrolled online survey compiled data on 930 mothers who nursed their infants while taking an antidepressant. Infant drug discontinuation symptoms (e.g., irritability, low body temperature, uncontrollable crying, eating and sleeping disorders) were reported in about 10% of infants. Mothers who took antidepressants only during breastfeeding were much less likely to notice symptoms of drug discontinuation in their infants than those who took the drug in pregnancy and lactation.[10]


    Possible Effects on Lactation:
    The SSRI class of drugs, including citalopram, can cause increased prolactin levels and galactorrhea in nonpregnant, nonnursing patients.[11][12][13][14] In a study of cases of hyperprolactinemia and its symptoms (e.g., gynecomastia) reported to a French pharmacovigilance center, fluvoxamine was found to have a 3.9-fold increased risk of causing hyperprolactinemia compared to other drugs.[15] The prolactin level in a mother with established lactation may not affect her ability to breastfeed.

    In a small prospective study, 8 primiparous women who were taking a serotonin reuptake inhibitor (SRI; 3 taking fluoxetine and 1 each taking citalopram, duloxetine, escitalopram, paroxetine or sertraline) were compared to 423 mothers who were not taking an SRI. Mothers taking an SRI had an onset of milk secretory activation (lactogenesis II) that was delayed by an average of 16.7 hours compared to controls (85.8 hours postpartum in the SRI-treated mothers and 69.1 h in the untreated mothers), which doubled the risk of delayed feeding behavior compared to the untreated group. However, the delay in lactogenesis II may not be clinically important, since there was no statistically significant difference between the groups in the percentage of mothers experiencing feeding difficulties after day 4 postpartum.[16]

    A case control study compared the rate of predominant breastfeeding at 2 weeks postpartum in mothers who took an SSRI antidepressant throughout pregnancy and at delivery (n = 167) or an SSRI during pregnancy only (n = 117) to a control group of mothers who took no antidepressants (n = 182). Among the two groups who had taken an SSRI, 33 took citalopram, 18 took escitalopram, 63 took fluoxetine, 2 took fluvoxamine, 78 took paroxetine, and 87 took sertraline. Among the women who took an SSRI, the breastfeeding rate at 2 weeks postpartum was 27% to 33% lower than mother who did not take antidepressants, with no statistical difference in breastfeeding rates between the SSRI-exposed groups.[17]


    Alternate Drugs to Consider:
    Escitalopram, Nortriptyline, Paroxetine, Sertraline


    References:
    1. Weissman AM, Levy BT, Hartz AJ et al. Pooled analysis of antidepressant levels in lactating mothers, breast milk, and nursing infants. Am J Psychiatry. 2004;161:1066-78. PMID: 15169695
    2. Heikkinen T, Ekblad U, Kero P et al. Citalopram in pregnancy and lactation. Clin Pharmacol Ther. 2002;72:184-91. PMID: 12189365
    3. Berle JO, Steen VM, Aamo TO et al. Breastfeeding during maternal antidepressant treatment with serotonin reuptake inhibitors: infant exposure, clinical symptoms, and cytochrome P450 genotypes. J Clin Psychiatry. 2004;65:1228-34. PMID: 15367050
    4. Franssen EJ, Meijs V, Ettaher F et al. Citalopram serum and milk levels in mother and infant during lactation. Ther Drug Monit. 2006;28:2-4. PMID: 16418683
    5. Schmidt K, Oleson OV, Jensen PN. Citalopram and breast-feeding: serum concentration and side effects in the infant. Biol Psychiatry. 2000;47:164-5. PMID: 10664835
    6. Hendrick V, Smith LM, Hwang S et al. Weight gain in breastfed infants of mothers taking antidepressant medications. J Clin Psychiatry. 2003;64:410-2. PMID: 12716242
    7. Lee A, Woo J, Ito S. Frequency of infant adverse events that are associated with citalopram use during breast-feeding. Am J Obstet Gynecol. 2004;190:218-21. PMID: 14749663
    8. Gentile S., Vozzi F. Consecutive exposure to lamotrigine and citalopram during pregnancy. Arch Womens Ment Health. 2007;10:299-300. PMID: 17763980
    9. Werremeyer A. Ziprasidone and citalopram use in pregnancy and lactation in a woman with psychotic depression. Am J Psychiatry. 2009;166:1298. Letter. PMID: 19884241
    10. Hale TW, Kendall-Tackett K, Cong Z et al. Discontinuation syndrome in newborns whose mothers took antidepressants while pregnant or breastfeeding. Breastfeed Med. 2010;5:283-8. PMID: 20807106
    11. Arya DK, Taylor WS. Lactation associated with fluoxetine treatment. Aust N Z J Psychiatry. 1995;29:697. Letter. PMID: 8825840
    12. Egberts ACG, Meyboom RHB, De Koning FHP et al. Non-puerperal lactation associated with antidepressant drug use. Br J Clin Pharmacol. 1997;44:277-81. PMID: 9296322
    13. Iancu I, Ratzoni G, Weitzman A et al. More fluoxetine experience. J Am Acad Child Adolesc Psychiatry. 1992;31:755-6. Letter. PMID: 1644743
    14. Gonzalez Pablos E, Minguez Martin L, Hernandez Fernandez M et al. [A clinical case of galactorrhoea after citalopram treatment]. Actas Esp Psiquiatr. 2001;29:414. PMID: 11730581
    15. Trenque T, Herlem E, Auriche P, Drame M. Serotonin reuptake inhibitors and hyperprolactinaemia: a case/non-case study in the French pharmacovigilance database. Drug Saf. 2011;34:1161-6. PMID: 22077504
    16. Marshall AM, Nommsen-Rivers LA, Hernandez LL et al. Serotonin transport and metabolism in the mammary gland modulates secretory activation and involution. J Clin Endocrinol Metab. 2010;95:837-46. PMID: 19965920
    17. Gorman JR, Kao K, Chambers CD. Breastfeeding among women exposed to antidepressants during pregnancy. J Hum Lact. 2012;28:181-8. PMID: 22344850



    Substance Identification:


    Substance Name: Citalopram

    CAS Registry Number: 59729-33-8

    Drug Class:
    Antidepressants
    Serotonin Uptake Inhibitors

    Administrative Information:


    LactMed Record Number:
    322


    Last Revision Date:
    20120605

    Disclaimer: Information presented in this database is not meant as a substitute for professional judgment. You should consult your healthcare provider for breastfeeding advice related to your particular situation. The U.S. government does not warrant or assume any liability or responsibility for the accuracy or completeness of the information on this Site.



    merinasmommy
    by on Jan. 14, 2013 at 4:36 PM
    i may talk to my doctor and see if i can try something else.i had a hard time getting dd to wake up (like would sleep 8+ hours from day 1)and i wasnt on anything so i cant imagine anything worse


    Quoting LoveMyCuties612:

    I was on celexa as well! Oh God did.it help me. I have been a beast while off of it but when.I looked it up on kellymom.com it said with that particular antidepressant it leaves traces in breastmilk. It didn't way that it will harm baby, but for me I was too scared to go back on it. I guess if u know yourself well enough to know that the benefit of you taking it outweighs the possible effects of it on the baby then I'd take it. I remember reading that it can make babies more sleepy. I'm not sure. I hope someone can give u more feedback! I've considered going back on it MANY times but I'm too weary :/

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    KylersMom8-16-7
    by Silver Member on Jan. 14, 2013 at 4:37 PM
    I'm taking Celexa and breastfeeding. My son was 14 months when I started and I haven't had issues and neither has my son. I'm on 10mg but thinking about getting 20mg.

    I was told that it could cause my son to be sleepy and irritable but from what I read that wasn't common. I was also told it decreases milk supply but according to Lactmed it INCREASES supply and can start lactation in non-lactating people:-)
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    ceckyl
    by Kyla on Jan. 14, 2013 at 4:41 PM
    Don't get different opinions. Opinions re just that. Get the facts. Either lactmed or dr hales hotline are accurate sources.


    Quoting missyice:

    It can be so hard to know with medication! I am on tablets for high blood pressure. One of the warnings on the packet says not to use while breastfeeding! This medication was perscribed for me while at the hospital, after just having had my daughter, and while breastfeeding. Maybe get a few different opinions on what is safe while breastfeeding.

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