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I have PPD and I need help.

Posted by on Apr. 17, 2013 at 10:14 AM
  • 20 Replies
There, I said it. Now that I've got that off my chest... I have 4 children and depression has been an issue for me ever since I was pregnant with #2. The trouble is that I'm very loathe to use medication - particularly while pregnant or breastfeeding. I have tried MANY different medications over the years and have often had to switch because of reasons such as insurance issues or the fact that I have often gotten headaches because of specific medications. I have the following troubles: 1 - I do not have a primary doctor in my new town so it might take a while for the new doc to be able to see my extended medical history and see all of what I have tried before (which is quite a bit - even I don't remember everything I took over those 10 years) and 2 - I am currently EBF with my youngest, who is only 16 weeks old (tomorrow). I have tried everything I could think of to work through my depression without medication (cutting back on caffeine, drinking more water, getting more sleep, eating less processed foods, eating more omega 3's, eating less refined sugars, exercising, looking on "the bright side" etc...) but I have to throw in the towel. It just isn't working. And, what's more, not only am I tired and sad all the time... I am also very space-brained and irritable... and my family does not deserve to have me snap at them all the time. PLEASE tell me there are breastfeeding moms out there who have been able to work through their depression somehow? Are there safe medications? Or will I have to stop breastfeeding if I start any medications at all? I want to do the best for her, for me and for everyone else in the family. I'm ... really lost. This is killing me.
by on Apr. 17, 2013 at 10:14 AM
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Replies (1-10):
Analugojana
by Christine on Apr. 17, 2013 at 10:19 AM
2 moms liked this

There are DEFINITELY safe meds. Zoloft is one of the safest. Check lactmed for specific meds. Better sane breastfeeding momma than depressed breastfeeding momma or formula feeding. Take care of yourself. *hugs*

K8wizzo
by Kate on Apr. 17, 2013 at 10:21 AM

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.

    PolishMamma2
    by Marta on Apr. 17, 2013 at 11:02 AM
    1 mom liked this

    I took Zoloft for a year after my DD was born and for 8 months after my DS was born. Its safe while nursing. It gave me headaches for about a week or so when I first started but that's something you have to expect. Any med. Is going to take some getting used to. I also take a B complex, and excersize is good too. And Zoloft is really fairly priced. I hope you feel better soon.

    LilMansMom105
    by on Apr. 17, 2013 at 12:23 PM
    1 mom liked this

    I have PPD, too. It took me awhile to recognize it b/c my symptoms are not the "typical" ones we always hear about. Yes, I get moody and am exhausted, but my biggest issue  is extreme anxiety and concern for babies wellbeing. Now that might seem "normal" but let me tell you, its not. I have: Auditory hallucinations ( i "hear" him screaming in pain and crying loudly when I'm not near him), I panick if I'm not holding him, or touching him if someone else is holding him, I rarely sleep because I have to lay there and watch him breath, If I DO leave the room he is in I panick and can barely go back in b/c I fear he will no longer be breathing and I don't want to find him like that, I take pictures of him like normal moms only in my head im telling myself its so "i can remember him when hes gone".  Like you, it was hard for me to admit this, and I DID NOT want to use meds. So the only person I have told is my husband. He has been so amazingly supportive, and we have been working thru it together. The major help in this situation is that every morning and every night he asks me how Im feeling and what is bothering me the most and that moment. Then we talk it thru and rationalize it. (No, he wont die if I leave the room. No, he's not screaming while im in the bathroom.) Its so hard to explain all this on here, and I'm sorry its so long. I guess I just want to let you know you're not alone, and meds arent the only answer :)

    Ptitchou
    by on Apr. 17, 2013 at 12:36 PM
    The risks of Zoloft for me are greatly outweighed by the risks my children suffered when I was suffering PPD. And I've done much of the same naturally.
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    Drienne13
    by on Apr. 17, 2013 at 1:24 PM

    I had severe PPD psychosis after my second baby. For some (like myself)... cutting back on caffeine is not enough, it must be completely eliminated. Caffeine is in a lot of things that people don't realize, besides coffee. Like:  tea (including green tea), chocolate (of any kind), sports drinks, pain medication, pop etc... 

    I wish I had known how caffeine affected me back after the birth of my baby. Things would have gone so much better.

    Since then I have also learned that Wild salmon oil is a natural mood stabilizer & A vitamin D deficiency really causes a lot of people to experience depression / mood disorders. Low blood glucose levels can really have a negative impact on mood.   I'm not Diabetic, but I often have low blood sugar.


    Tckosdk.2012
    by Bronze Member on Apr. 17, 2013 at 1:33 PM

    Since it may be a while for you to get in with a primary dr can you talk to your OB?

    chazzamatazz
    by on Apr. 17, 2013 at 3:00 PM

    Hi! Sorry I wasn't able to get back here sooner - we were having internet troubles all of a sudden.

    I'm pretty down on myself right now because I thought I had been doing well - I went over a year and a half without any medication at all, but now it rears its ugly head again.

    I will check out the resources posted real soon and I really appreciate the personal experience responses as well. It makes me feel like there's a lot of hope for my situation. So, thank you for that!

    chazzamatazz
    by on Apr. 17, 2013 at 10:34 PM



    Quoting LilMansMom105:

    I have PPD, too. It took me awhile to recognize it b/c my symptoms are not the "typical" ones we always hear about. Yes, I get moody and am exhausted, but my biggest issue  is extreme anxiety and concern for babies wellbeing. Now that might seem "normal" but let me tell you, its not. I have: Auditory hallucinations ( i "hear" him screaming in pain and crying loudly when I'm not near him), I panick if I'm not holding him, or touching him if someone else is holding him, I rarely sleep because I have to lay there and watch him breath, If I DO leave the room he is in I panick and can barely go back in b/c I fear he will no longer be breathing and I don't want to find him like that, I take pictures of him like normal moms only in my head im telling myself its so "i can remember him when hes gone".  Like you, it was hard for me to admit this, and I DID NOT want to use meds. So the only person I have told is my husband. He has been so amazingly supportive, and we have been working thru it together. The major help in this situation is that every morning and every night he asks me how Im feeling and what is bothering me the most and that moment. Then we talk it thru and rationalize it. (No, he wont die if I leave the room. No, he's not screaming while im in the bathroom.) Its so hard to explain all this on here, and I'm sorry its so long. I guess I just want to let you know you're not alone, and meds arent the only answer :)

    I thought I was alone in the sort of parenting paranoia I have when I have little ones - until I talked to a few friends. I always worry about their safety - even when they're laying safe in a crib and I walked through the checklist a half-dozen times. I'm also waking up several times a night to make sure they're breathing - and the word of DH or another family member isn't good enough... I need to see it with my own eyes or feel it against my hand. 

    It sounds like you have this paranoia a lot more extremely than I do, though. If it helps to know, it has gotten better for me as she's gotten older (as it did with my other girls) but this particular time around it has been worse for some reason. :/


    chazzamatazz
    by on Apr. 17, 2013 at 10:38 PM

    Quoting Tckosdk.2012:

    Since it may be a while for you to get in with a primary dr can you talk to your OB?


    I had to have a friend or my husband drive me 30 minutes to see an OB because there are none in my small town. Once a week, a Midwife from their hospital comes to the small clinic here to see people. I'm going to see if I can make an appointment with her about it - she knows me pretty well and I felt really comfortable around her.
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