Hi,
I saw your post and some of the replies and thought I would offer some advice. I am a Psychiatric Nurse working for a Perinatal Mental Health Team. I have read through the post on Kellymom and much of the info is ok, but this is an American Website so the drug names are different and the licensing for medication in America is also different (FDA).
There are number of issues with breast feeding and medication of any kind.
The first issue is the balancing of risk. What do I mean by this, well there are risks to breastfeeding whilst on a medication and there are risks to not breastfeeding. Let me try and be clearer?
Most medications including Antidepressants are passed in breast milk. The amount depends on you, your diet, the dose of medication, other medications you might be taking (these can affect the level of other drugs in your body). Then there is the issue of if you are established on a medication and breastfeeding or just starting and breastfeeding. Yes its quite complex.
The other issue is if you don't take medication but need it and breastfeed, because stress hormones such as Cortisol can also be passed in breast milk and some studies have shown some detriment to the infant also.
The important rule I think and what I would be considering with a new mum is a/. have i tried everything else? Ask your GP for counselling or Cognitive Behaviour Therapy. Have I had my bloods tested for Thyroid and Anaemia, the World Health Organisation estimate the rate of Nutritional Anaemia in new mums to be almost 60%. Both of these issues can affect mood and Thyroid can cause Anxiety.
In terms of medication when breastfeeding, if you take 20mg of a medication, much of this will be passed through, most of the anti depressants show in breast milk between 4% and 8% of the mothers dose. Many of them are hardly detectable in the babies blood serum (Show in blood testing).
In the UK we use ToxBase as professionals which is the UK Territology database and uses the latest research findings. We also use the Maudsley Prescribing Guidelines (2010).
Certainly the NICE Guidelines (2007) state that Sertraline is an effective and safe Antidepressant for pregnancy and Breastfeeding. In pregnancy Paroxetine should be avoided but it is safe in breastfeeding as far as the literature suggests.
No one drug is licensed for use in pregnancy and breastfeeding in terms of Anti Depressants. This is because we cannot ethically or legally do a study where with give pregnant and breastfeeding mums medication to see what effect it has on the baby. But it is estimated that of all the defects and malformations in new born babies (about 1 in 40 pregnancies) only 5% are linked to medications.
I would disagree with the point on Kellymom about the time frames for SSRI's to work. We would suggest that any Antidepressant (SSRI) will take between 4-8 weeks to be effective and the first 2 weeks can make you feel worse.
I hope this helps and hasn't confused you further, but there is help available. Please talk to your Midwife, GP and/or Health Visitor.