bfeeding, PND and anti depressents, URGENT advice wanted please

[4madboys]

hi i am posting this on behalf of a friend, she is bfeeding her 7mth old, who is pretty much exclusively bfed, (doing BLW) and she has been suffering from quite bad pnd, feeling suicidal, unable to cope etc.

she has been backward and forwards to her gp who have been useless pretty much.

she went again today and they have said she MUST stop bfeeding and start taking citalopram and she is on the 'waiting list' to see a psychiatrist oh and she can have counselling if she pays for it....

she REALLY REALLY REALLY DOES NOT WANT TO STOP BFEEDING, is absolutely gutted, so i said i would ask here and see if this medication is ok with feeding or if there is an alternative, and get her some advice that she can take back to her gp.

so please help

[vonsudenfed]

I took Citalopram and breastfed - from about 8 or 9 months.

My GP gave me an excellent list of ADs and their status for bf - sadly it was just a photocopied bit of paper.

But - as I remember - Citalopram doesn't have as much data on it as some of the other ADs, but is fine. I had a very good GP then, so I know this to be true

Will go off and do some research and come back.

[4madboys]

oh thankyou thats great, anything will be of help, honeslty what is it with gp's being so quick to just say stop bfeeding

[vonsudenfed]

Right, here is the thing she needs - BreastFeeding Network flyer about how of course she can take it with care!

www.breastfeedingnetwork.org.uk/pdfs/Postnatal-depression-and-antidepressant-use-in-breastfeeding.pd f

Also the Kellymom info:

www.kellymom.com/health/meds/antidepressants-hale10-02.html

Celexa is Citalopram in the States. Note that that is just two incidences of sleepiness - and in much younger babies.

And here:

drugsafetysite.com/citalopram

Worth remembering that when you take it is important - it peaks in milk 4 hours after the pill is taken. I took mine at 6pm as doing no night feeds then...

hope this helps

[vonsudenfed]

Mine didn't, bless her cotton socks. I was so lucky! She just gave me all the info and told her to make up my own mind.

If your friend is still worried, Prozac has by far the best - i.e. most tested - safety record with bf. But dd looks just fine after my 6 months on Citalopram!

[NotSoRampantRabbit]

I bf for over a year on sertraline.

It is really important that your friend is supported to continue bf. I think it's true to say that PND will not be helped by stopping something that she is doing WELL and that has untold benefits in terms of boosting 'happy' hormones.

If I were her I would see a different gp.

[TinkerBellesMum]

I was on Citalopram (doesn't suit me) but was put on it because it is suitable for a nursing mother. Is she being seen in a general pyschiatric out patient or at a mother and baby unit? It could be an idea if she's not at a M&B to get seen at one because they are much more knowlegable to deal with a nursing mother. It's only really strong AD's and antipyschotics that are a problem.

[TinkerBellesMum]

Just read she saw her GP, she needs a proper referal or to pay lip service (as a BLW parent she's probably used to doing that anyway ) "oh yes, of course I stopped the breastfeeding..."

[4madboys]

thankyou ladies i have given her a link to this thread, she really isnt up to 'fight the battle' ifykwim.

dont think she could go to a mother and baby unit as she has two other children (three kids under the age of 5) so she couldnt leave them.

[TinkerBellesMum]

I'm not talking about as an in patient, where I go there is a creche and they arange everything for parents of older children around school hours. It's better seeing someone who's specialism is pregnancy and breastfeeding because they won't tell you stupid things like stop BFing!

[NotSoRampantRabbit]

Hello 4madboys friend

There is alot of support on mumsnet - if you have access to the internet I definately recommend using it, both for practical and emotional help.

Don't stop bf - you are doing an amazing job and there is no clinical evidence to suggest a significant risk to babies when taking commonly prescribed anti-depressents. In my case can particularly vouch for sertraline.

I'm sure you have spoken to health visitors, but if not, do ask whether there are any PND groups in the area. Sure Start centres usually have something. Sounds like your gp is not remotely clued up, so it may be that there is something out there that they just don't know about. It really helps to talk to other women and realise that you are not alone.

If you can face it, try and see a different gp. And take the information posted on this thread. It is ridiculous that you should be told to stop bf immediately.

Feel for you, I really do. Just wanted you to know that I had severe PND with first ds but am back now - ad's really really helped. I hope you get the support you deserve.

xx

[4madboys]

oh i dont know if there is anything like that where she lives, she is in liverpool.

she cant get homestart help as she lives in the wrong bit of the city.

[NotSoRampantRabbit]

There will definintely be Sure Start in L'pool. Hang on - will google.

[NotSoRampantRabbit]

There will definintely be Sure Start in L'pool. Hang on - will google.

[NotSoRampantRabbit]

sure start in liverpool

[LackaDAISYcal]

my pshych at the mother and baby unit of the psych hospital in Leeds (I attend as a day patient only) had me on sertraline as it comes through in the milk the least and is the most recommended for BFing mothers. fluoxetine and paroxetine get through but in slightly bigger amounts. Citalopram afaik gets through more, but I don;t have any expereince of taking that one

there are other alternatives to citalopram and your friend should ask for an urgent psych referral to someone with experience of PND as they are more up to date with things and knowledgeable than GPs, dealing with PND all the time as they do.

oops, sorry just read she is waiting on a pshych referral. surely the GP can talk to someone to get a recommendation for a different drug or the check that citalopram is OK.

i think with these things, that a little of the drug in the BM is better than the baby not being BF at all.

[SJLTM]

Please keep breastfeeding ! I didn't let on how fed up I was !! Thought they would take my baby away ! started sertraline at 6 week check and continued to BF for over a year. It can be really hard with 3 under five .

[TinkerBellesMum]

"If citalopram is required by the mother, it is not a reason to discontinue breastfeeding." from LactMed which also says it can cause an increase in lactation.

"If fluoxetine is required by the mother, it is not a reason to discontinue breastfeeding." Also from LactMed

Don't worry about councelling (just reread the OP) the hospital will sort that out with her.

[tiktok]

Fantastic service from mumsnetters

Nothing to add to this great info, except to say her baby is 7 mths - the further a baby gets from being a newborn, the more robust we can expect his 'system' to be, and the issues that might apply to a prem or a newborn don't apply.

All good wishes to her - she really does not have to stop bf!

[4madboys]

THANKYOU LADIES, I have sent her this thread, she will be so pleased xxxxxx

[tiggerlovestobounce]

Froma psychiatric journal:

Citalopram
Citalopram concentration in breast milk has been studied in smaller samples and the milk/plasma ratio has been found to be relatively high, as is the calculated infant dose (Jensen et al, 1997; Spigset et al, 1997; Schmidt et al, 2000). None of the infants studied displayed detectable levels of citalopram or its metabolite, but possible symptoms such as somnolence, restlessness and irritability have been attributed to maternal citalopram intake. However, Lee et al (2004a), in their prospective observational cohort, studied the frequency of adverse events in 31 infants exposed to maternal citalopram through breast-feeding. Citalopram was found to be safe and there were no statistically significant adverse events or any developmental problems.

link to full article

[4madboys]

thankyou again ladies, but we now have a further problem, her gp has told her dh that he thinks part of the 'problem ie her depression' is because she is bfeeding and so he is making her stop, she is trying to bfeed secretly..... arghhhhhhhhhhh i cant help her in person as i am miles away.

where the fuck do drs get off making judgements like these?

[TinkerBellesMum]

That's disgusting! Get her to complain to the practice manager. If she isn't seen to be making a fuss her DH will feel the Dr was right. Was she with him then or did the GP speak to him separately?

If she is struggling to do something like that, would she let you help her?

[4madboys]

i am in norwich, she is in liverpool i cant get to her, i am txting her, i will see if i can get the no of her gp? but they wont talk to me about it will they, patient confidentiality and all that....

[VictorianSqualor]

She must complain.
Not everyone under that doc will have you as a friend to help

I was ta the GP's recently about PND, first we decided I should come off my pill (thankfully it seems that was causing it) and if it didn;t make any odds we were going to find an anti-d i could take whilst BFing.
Lots of people take meds whilst BFing just means doc has to be more thorough in what he prescribes.

[tiggerlovestobounce]

Is there no other GP she can see in the practice?
I think that there is some suggestion that in this sort of situation it is actually better for the depression if the mum carries on breastfeeding

link

another one