To think GP’s should encourage breastfeeding?

[Sofedup2022]

I’m so fed up and furious this evening! I’ve been struggling with anxiety and depression for a few months now and have an 11 month old baby.

I finally worked up the courage to book a doctors appointment - which was a nightmare in itself as it’s impossible to book into our local surgery. I finally got a telephone appointment with a nurse this morning.

I explained how I was feeling and she asked if I was breastfeeding. Once I said yes she said that meant I couldn’t take any drugs and the only option was to refer me to counselling. I politely said I’d been told by the breastfeeding network that there were antidepressants that were safe while breastfeeding, at which point she said she’d speak to the junior doctor and call me back.

She rang me back to tell me that almost all antidepressants aren’t safe while breastfeeding as it passes to the baby so I had two options

1. Take Amitriptyline which may make the baby sleepy
2. Stop breastfeeding and take another antidepressant!

I was pretty irritated but decided I would try the Amitriptyline. I have gone to take my first dose this evening and realised I have been prescribed 10mg. I have checked the NICE guidelines and that is the dosage they prescribe for back pain, while they advise at least 50mg for treating depression.

I am so furious. It took a lot for me to make the appointment and they made me feel like a selfish mother for wanting drugs and have essentially made it clear that if I want anything that will actually help me they expect me to stop breastfeeding.

Breastfeeding has been hugely protective for my mental health and has been one area of motherhood that I feel really good about. I have no intention of stopping and luckily know enough to query what she said initially or I’d have ended up stuck on an 18 month long waiting list for counselling! I do have counselling privately which I did explain to her, it’s not that I’m looking for a magic pill to fix everything, but I have taken antidepressants in the past and they were the only thing that was truly effective.

WIBU to complain? Should I book another appointment? Who would I even complain to?!

@Jellyfishjean

They're just telling you the scientific facts.They can't change them just because you don't like them.

But the "facts" they are giving are incorrect There are antidepressants that can be and are safely used in pregnancy and while breastfeeding.

I've been in the same position op. GP told me categorically there was no antidepressant they could prescribe while I was breastfeeding, but referred me to the perinatal mental health team who were happy to prescribe whatever i wanted.

Breastfeeding women aren't included in medical research, which tend to only focus on male bodies and ignore pregnancy, breastfeeding, menstrual cycles etc.

But you are being unreasonable - doctors should encourage whatever is right for that mum & baby. Mode of feeding is not important at all beyond convenience and maternal mental health.

Ring back up and ask to speak to a senior GP.

Don’t take it too personally. I know lots of ADs are safe while BF, but a lot of docs would take the view that the fewer the better, and would assume that at 11 months you were close to weaning,

You should absolutely advocate for yourself but just insist on GP phoner, and have info to hand.

I’m a psychiatrist and although obviously this is not individual advice there are definitely medications you can take! Sertraline would be first choice and I have considered starting it myself when breastfeeding for postpartum anxiety.
Passes into milk in minimal amounts, very unlikely to cause any SE for baby and unlikely to impact you when your child is relatively older and you have well established supply.

Unfortunately at least in my area you wouldn’t meet criteria for perinatal mental health team as your child is nearly one.

With respect to other health professionals , it sounds like the problem is that you didn’t speak to a GP! A nurse in a GP practice is not best placed to be giving advice and I can assure you having been one that the junior doctor is definitely not the right person either!
An experienced GP should have been able to give you the correct advice and indeed if they couldn’t they should have found out and come back to you.

I am very surprised by the amitripyline- but the dose itself is fine at least for initiation- Start low and go slow. However I admit I only tend to use it as an adjunct…

I am shocked that people are saying you are being unreasonable. You absolutely can take an antidepressant when breastfeeding. Please feedback the learning need and speak to another doctor.

Speak with your health visitor? I had a brilliant one who got me the help I needed, I know it's luck of the draw but it's definitely an avenue to explore. My SIL has some severe mental health issues, and is on sertraline and has been breastfeeding my nephew for 10 months now with no problems, so I would agree you have been misinformed. A lot of GPs don't seem to have much knowledge with female specific health issues I've found.

I’d just add further to my previous comment- have you been counselled about amitripyline side effects?
In real life it’s unlikely to make any difference and especially when presumably your child’s main nurtritional needs are met through food. I can say certainly it not the safest in breastfeeding although the risks are very small.
If you don’t feel confident absolutely complain.
I use choice and medication website as well as maudsley guidelines.

Surprised they didn't go with sertraline. That usually seems to be the favourite for pregnant and breastfeeding mums.

Maudsley guidelines state:

It is usually inappropriate to stop breastfeeding except when the currently prescribed drug is contraindicated in breastfeeding.

There is a table with excellent summary for each drug.
As stated sertraline and mirtazapine overall best evidence for safety.
Amitripyline has been associated with poor feed in and sedation in the infant.

Also this is keeping my brain going during Mat leave so at least there’s that!

Ask to speak to one of the GP partners - they'll be more experienced then the junior GP registrar

@Thefrenchconnection1

I'd just lie and say I'm not breastfeeding if I had reliable advice elsewhere. Go back and ask for one you know is safe.

So would I. If I was following the NHS guidelines I’d be fine with it.

Your GP is giving out inappropriate medical information and you need to file a complaint. The GP needs further training.

There are absolutely antidepressants that are perfectly safe for breastfeeding. If your GP has spent any effort at all the information is easily accessible and the first recommendation is never Amitriptyline.

After GP appointment at four weeks post partum, I had a choice of either paroxetine or sertraline for pnd while breastfeeding. I opted for sertraline with full support of my gp and immediately started to feel better. It took a while to get back to my former self but I got there. And I breastfed my baby until almost two years old.

My GP prescribed sertraline but only 'as baby is weaning and won't be having as much milk anymore'. They also suggested I completely stop breastfeeding so I could take the medication! I was so upset I spoke to my Health Visitor and some breastfeeding support groups and decided to take the medication and continue breastfeeding on their advice.

I'm so glad I did. A year on I'm still breastfeeding daily and on my medication which has made a real difference to my life.

I’ve found the default when bf is to say you can’t have the medication. So far I’ve been denied antibiotics and decent antihistamines. Recently I kicked up a major fuss as they wanted to do a painful medical procedure without any painkillers or sedation because I’m bf. I checked on the bf network (which is the site with all the relevant info) and they did some reading up and said yes you’re right the painkillers and sedatives are safe.
If I hadn’t known where to find the info I would have either had to stop bf or suffered.
Frankly it’s an appalling failure of the nhs.

@Jellyfishjean

They're just telling you the scientific facts.They can't change them just because you don't like them.

No, they are misinformed or not up to date on the research. There are SSRI's which are safe to take during breastfeeding as the molecule is too large to pass into the breast milk.

@ParalysisByAnalysis

Why are you believing the “breastfeeding network” (whatever that is) over the opinion of two doctors?!

Also, with the best will in the world, your almost-1 year old will benefit much more from you being in good mental health, than your breast milk.

Because Wendy Jones at the Breastfeeding Network did her PhD on Drugs in Breastmilk, so knows considerably more than the majority of GPs?

Not connected to breast feeding but a family member has had this, being prescribed a non therapeutic dose of anti depressants and then being startled when challenged about that.

And as you say, impossible to be seen properly, you need face to face appointments for mental health I would say

The specialist pharmacist who writes the breastfeeding network guidance on medication is a great source. In fact all of the BFN guidance is based on reviews of the evidence whether it's around healing sore nipples or best advice on latching. Its the best source we have for breastfeeding information in this country. I hope you can discuss this with a GP who understands OP.

@lochmaree

I started taking a really low dose of sertraline while bf my 18m old. I think its the preferred SSRI for bf mums but citalopram could also be used. I'm also pregnant and there's been no issue with me continuing the sertraline.

@ParalysisByAnalysis OP clearly said that bf helps her mental health, why should she have to stop simply because her HCPs have given incorrect advice? bf past 1 year has benefits for mum and baby, no reason why she can't continue. also worth noting that some mums experience a temporary decline in mental health after weaning from bf due to the hormonal changes, so stopping may make her mental health worse.

Can 100% confirm, as someone currently signed off work for severe depression that really only became unmanageable once I started cutting down on feeds. The hormonal rebalancing is like nothing I’ve ever experienced before. I’m not in the least bit sad, and yet I physically can’t stop crying at various points throughout the day. It is truly the strangest sensation.

I’m so sorry OP!

I’m breastfeeding a two year old, AND pregnant, and on an antidepressant. I was on it throughout my last pregnancy (have been on it for 16 years), all with the full knowledge and support of several GPs, obstetricians and midwives.

I’d book an appointment with a senior GP and specifically not the nurse.

Why are you believing the “breastfeeding network” (whatever that is) over the opinion of two doctors?!

GP's are educated on breastfeeding just like they are about peri-menopause. They know fuck all.

Be very careful of Amitriptyline. I was prescribed it as a painkiller. It is also an antipsychotic drug. It was not the only factor, but contributed to me having a nervous breakdown two years ago.

Do your own research but don't take it without some background reading. This is from the NHS...

www.nhs.uk/medicines/amitriptyline-for-depression/

OP am I reading correctly that you didn't even speak to a GP directly and this was relayed by the nurse? Surely you need to speak to a doctor to be prescribed antidepressants!
Very disappointing attitude, I would speak to HV and try to fit an appointment with a more senior doctor

Good for you for bf so long, you should be supported to keep going

[quote lochmaree]@KindlyKanga but the OP clearly wants to keep bf, so her doctor should support and encourage it. of course if a mum doesn't want to bf then they should be supported to stop.[/quote]
I didn't say I didn't want to did I... I did, it wasn't working, it was destroying my mental health.

Anyway this isn't about me. I was just making the point that I don't think it is a once size fits all answer for the GP. They need to advise the patient in front of them.