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Postpartum Depression

Anti-depressants and Breastfeeding
By Karen Kleiman, MSW
Karen KleimanQ. My family doctor has already diagnosed my depression and wants to start me on meds. I am breastfeeding my 6 month old daughter, and my doctor says I have to wean her before beginning any meds. Weaning is NOT an option for us right now (many reasons factor in this decision including that she refuses a bottle and we are moving in a few weeks). I think I'd feel guiltier over the decision to wean before we were ready than anything else. I'm looking for information that I can take to my doctor to help in my treatment and to help set my mind at ease. I know other women have taken Zoloft and Paxil and continued to breastfeed but I need some definitive reassurance. I've tried looking on the internet but I get SO overwhelmed and confused that I don't know where to begin. I'm also wondering if there are any other things I can do to help control my depression that don't involve medication.

A. I'm not surprised that you're overwhelmed by the info you find while research breastfeeding and medication; there is a great deal of contradictory info out there! Let me try to give you some of the facts, and while I don't want to oversimplify what is a very complicated decision, perhaps if I outline some of the info, you and your husband and your doctor can come up with a plan that feels best for you.

Remember that the decision to breastfeed and take medication is a very personal one and you are going to get LOTS of differing advice if you ask people their opinions. Some say wean first. Some say taking meds is fine. Some say it depends on your symptoms, the age of your baby, your history of depression, what medication, etc. etc. etc.

So here are some facts:

  1. ALL antidepressants are excreted into the breast milk.
  2. No SSRI appears safer than another
  3. There is no data to support neonatal medication accumulation
  4. No treatment-emergent adverse events noted with Zoloft, Paxil, Prozac
  5. Untreated maternal depression has a negative impact on infant
  6. Decision to use antidepressants with a mother who is breastfeeding must always be a risk/benefit analysis

In my practice, we feel very strongly about a woman's need and desire to continue breastfeeding. And although we will support her decision to do so, if medication is indicated and she does NOT want to expose the baby to the medication, then we need to seriously evaluate the situation to determine whether it is best to consider weaning so she can take the medication or offer her information about taking the medication while nursing. In other words, if the issue is that you need the medication, then YOU need to decide whether you should do that while you are breastfeeding or whether you should wean. And by the way, if your doctor insists that you must wean before taking the antidepressants, you might want to get another opinion.

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