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Breastfeeding Moms Breastfeeding Moms

Ppd

Posted by on Oct. 9, 2013 at 9:01 AM
  • 10 Replies
Are there any meds safe to take for ppd while breastfeeding? I'm going to the Dr Friday and I'm going to ask to be put in meds, but I still want to breastfeed.
by on Oct. 9, 2013 at 9:01 AM
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Replies (1-10):
MamaToCollin
by Bronze Member on Oct. 9, 2013 at 9:04 AM

Zoloft is the preferred I believe.

Schizomom91
by on Oct. 9, 2013 at 9:05 AM
Oh good!


Quoting MamaToCollin:

Zoloft is the preferred I believe.


gdiamante
by Group Mod - Gina on Oct. 9, 2013 at 9:41 AM

Yes, Zoloft is preferred.

Peanut120
by on Oct. 9, 2013 at 9:47 AM

Kudos to you for acknowledging you're having some trouble and for getting help!  Very brave!

FlOrEs_21
by on Oct. 9, 2013 at 11:07 AM
1 mom liked this
I'm on zoloft. You could also be on Wellbutrin
ballerina.2006
by Member on Oct. 9, 2013 at 11:10 AM
1 mom liked this
I'm on Prozac. That and Lexapro are the two that work best for me not pregnant so it's best for me to stick with what works. My ob was fully supportive of putting me back on Prozac at the end of my pregnancy and having me bf on it.

Some things the benefits outweigh the risk.
aehanrahan
by Group Mod - Amy on Oct. 9, 2013 at 1:38 PM
Yes, you can take meds and keep breastfeeding! There is a list of preferred meds on kellymom.com.
Posted on CafeMom Mobile
Schizomom91
by on Oct. 9, 2013 at 3:03 PM
Thank you. I had ppd really bad with dd and quit breastfeeding. I'm starting to have it again, but I don't want to quit. I'm so glad there's meds I can take!


Quoting Peanut120:

Kudos to you for acknowledging you're having some trouble and for getting help!  Very brave!


Thunderbug75
by Amanda on Oct. 9, 2013 at 7:15 PM

 I was on Zoloft after having DS.  It worked OK.  But really going back to work was what really helped me.  I think it was just getting back on a schedule and getting out of the house everyday.  Good luck!

maggiemom2000
by Ruby Member on Oct. 9, 2013 at 7:51 PM
1 mom liked this

Zoloft is the first choice, but lots of others are safe as well:

http://kellymom.com/bf/can-i-breastfeed/meds/antidepressants-hale10-02/

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.


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