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?!

Yes yabu to complain. You can't breastfeed on antidepressants and the nurse offered you a choice. A choice. It might not have been want you wanted but complaining is hugely unfair on someone who was just doing their job. You should query the dose however if you think it's not enough.

OP as others have said, this information you were given was incorrect. You are absolutely right to be pissed off. I agree with others that you need to ring back and request a face to face appointment. A postnatal mum ringing in with symptoms of depression and they offer you a phone call from the practice nurse? Disgraceful! Take care

cherrytopcake you absolutely can though! Not all antidepressants of course and not all doses but your post is misinformed.

It's absolute bullshit that you can't take antidepressants whilst breastfeeding - however, some GPs are pig-ignorant when it comes to drugs and pregnancy or breastfeeding.

Luckily mine recognised that she wasn't an expert and referred me to a consultant specialising in such matters, who told me that venlafaxine is absolutely fine when breastfeeding, and wrote as such in my notes. That didn't stop a daft midwife telling me sternly that I couldn't breastfeed because of my antidepressants at 2am after an emergency c-section under GA - luckily DH was with it and told her to read my bloody notes. She still insisted she was right and called the on-call paediatrician to give me a talking to - who read my notes, looked at the midwife like and told me to crack on with breastfeeding.

Ask for a referral, your GP is being stupid.

A nurse is not an appropriate HCP to be talking to about mental health and the best treatment for you.

I advise you to insist on an appointment with a GP (not a junior one) and ask for sertraline.

If they won't give a mother of a baby under one a GP appointment to discuss her mental health, make a complaint.

And don't take amitriptyline. If you've read the breastfeeding network fact sheet on antidepressants you'll know that sertraline should be the first choice.

@cherrytopcake

Yes yabu to complain. You can't breastfeed on antidepressants and the nurse offered you a choice. A choice. It might not have been want you wanted but complaining is hugely unfair on someone who was just doing their job. You should query the dose however if you think it's not enough.

But you can! I am. With the full support and knowledge of several GPs who’ve seen me over time. And now that I’m also pregnant, an obstetric consultant and several midwives!

@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.

The breastfeeding network is run by pharmacist who are more qualified than GP to offer advice on medication.

Thank you everyone for all your advice I really appreciate it! To answer a few questions:

• when I made the appointment I asked to speak to a GP, the receptionist asked what it was about and didn’t mention the appointment was with a nurse. I have huge respect for nurses and have found nurse appointments really helpful in the past but was surprised that she would be the one to speak to me about this. I didn’t actually speak to a GP at all!
• I have no issue with taking a lower dose and then building up, but this wasn’t explained to me, she didn’t mention building up the dose, just told me to call back in a month and let them know how I was getting on.
• I haven’t ever taken amitriptyline before, I took fluoxetine years ago, but the nurse didn’t ask what I’d taken before or how I got on with it.
• I would be open to counselling and already have weekly counselling privately. I also know several people locally who have been put on 18 month long NHS waiting lists for it so it wouldn’t have benefitted me to ask for that through the GP.

My title was badly worded - I should really have said ‘to think GP’s should support mothers who want to continue to breastfeed to continue’ I appreciate that not everyone wants to/is able to and in those cases absolutely should not be pressured. But only a tiny percentage of women are still breastfeeding at 11 months in the UK and if we want to carry on I feel that GP’s should be trying to facilitate that and not telling mothers to give up to get the help they need!

I will be calling tomorrow to ask for an appointment with the GP and explain what’s happened.

It's a real shame that the nhs puts so much time and resource into promoting the Breast Is Best message and so little time and resource into ensuring health professionals are trained to support it.

Also a bit concerning that so many posters can't conceive of more knowledgeable bodies than their GP on this topic.

Please take this further OP, it's the only way to drive better awareness. I also found that bfing did wonders for my mental health and I hate the thought of anyone stopping before they're ready, simply because of bad advice.

@Sofedup2022 glad to hear you’ll be calling back and also glad to hear you have some talking therapy in place. I would be really surprised if amitryptiline is the best choice of antidepressant for you so I’m not sure I’d take it between now and then - I’d wait and discuss.
Hoping you have a better experience on Monday and feel better soon 💐

OP I had similar but where the doctors were actually encouraging me to continue breastfeeding and avoid medication as long as possible , I got to the point where I was desperate so they prescribed amitriptyline. This bit is important - you start at 10mg but it is safe to gradually increase the dose if you are not having unwanted side effects. So with the doctors agreement I went up to 50mg (they said it’s safe to go higher but I didn’t need to). So please don’t feel fobbed off by the low dose they are just trying to keep you and baby safe.

I don't think anyone should encourage breast feeding definitely not gps. It's personal choice

" I also know several people locally who have been put on 18 month long NHS waiting lists for it so it wouldn’t have benefitted me to ask for that through the GP."

Pregnant women and mothers of young babies are prioritised so you can access CBT much more quickly, for example, and there are usually mental health services that are specifically for mothers that you can access relatively quickly. Rightly so.

@collieresponder88

I don't think anyone should encourage breast feeding definitely not gps. It's personal choice

Well yes but in this case the OP has been clear that they are content breastfeeding and want to continue. They have been given incorrect advice of which part of it was to stop BFing which isn't necessary.

There are actually very few medications that are contraindicated in breastfeeding but many are “cautioned” as the drugs are found in milk. However, most of the time, that doesn’t matter.

Think about it - if the concentration in
Milk is the same as in blood, that’s not actually very much. You’d have to drink a lot of blood to get a decent amount of antidepressant 😀. And even then, there’s a step down - milk into infant’s stomach to liver to blood stream.

So not much at all, especially for an older baby.

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

The Australian equivalent is Rodney Whyte, (?White) at monash Uni a Melbourne. Spends a lot of time reassuring mothers and specialists alike that most so-called “contraindicated” drugs in breastfeeding women are absolutely fine.

The exceptions are ones that intuitively seem serious - lithium, warfarin and the like.

@TheKeatingFive

It's a real shame that the nhs puts so much time and resource into promoting the Breast Is Best message and so little time and resource into ensuring health professionals are trained to support it.

Also a bit concerning that so many posters can't conceive of more knowledgeable bodies than their GP on this topic.

Please take this further OP, it's the only way to drive better awareness. I also found that bfing did wonders for my mental health and I hate the thought of anyone stopping before they're ready, simply because of bad advice.

This ^^

I took sertraline OP whilst I was Bf. It helped a lot

I hope you are able to find someone helpful at your GPs as they’ve been very unhelpful so far.

I took citalopram throughout breast feeding my second (PND) and pregnancy and breastfeeding with my 3rd. My doctor said there was no definitive evidence that it wasn't safe and told me to make my own decision. I've no idea if she was right but it worked for me.

I don't have any idea how this will help you but my experience was fine 🤷🏻‍♀️

Also I currently take amitryptiline for chronic pain at 50 mg and it completely wiped me out. I'm permanently exhausted on top of the fatigue I previously had. It's a common side effect.

@collieresponder88

I don't think anyone should encourage breast feeding definitely not gps. It's personal choice

Of course it's personal choice but if a women wants to breastfeed she should be supported to do so - not given incorrect information about options for medication or told she should stop for no reason. Having to stop breastfeeding before you feel ready to do so is a big deal.

Op - I'd definitely phone and try and get an appointment with a GP this time. You could also try your health visitor- they might be able to refer to Counseling etc.

Probably is an idea to complain if you are up to it too - the lack of knowledge/training of some medical professionals about breastfeeding is shocking.

@PrivateHall On the contrary, I've never met a single midwife who is well trained in bf. I'm sure some do exist, but they're a rare breed - usually because they've fed their own babies, not via training.

I'm a BF peer supporter, with the Breastfeeding Network, and we were all told that our training is longer, more intense and in depth than the training midwives and HV's get. It's absolutely the bare minimum.