breastfeeding and antidepressants?

[haroldthecat]

I've just been diagnosed with PND and I'm due to see my Gp again next week to discuss medication. I really don't want to stop bf and my Gp said there were some drugs that are ok to use whilst bf. Anyone got any experience of this or advice? Not sure if i want to go down the medication route at all really. Thanks.

I took fluaxonal initally while breastfeeding and then changed to sertaline eight years ago. It made a massive difference to me as medication gave me the temporary lift to solve my problems.

Medication is great, but will not cure you on your own. I found the website

www.livinglifetothefull.com

excellent. It is a CBT site and helps you understand your thinking. Have you been offered any kind of councelling. If not it maybe worth talking to your health visitor to see if she can arrange support.

Most of the SSRI anti-d drugs are suitable for bfing esp. sertraline (the one I take and have taken since DD1 was 9m/o and have/am bf two other children whilst taking it with no ill effect [anecdata alert!]). Other Anti-ds are also safe for bfing but I have no experience of them.

Ask your Dr to check which ones he thinks is suitable for the kind of depression (PND with Anxiety, PND with OCD, etc etc) you have and check with Dr Thomas Hale's Medications and Mothers' Milk (the textbook for breastfeeding mothers and the drugs they can take) not the BNF (British National Formulary) which is very cautious and doesn't seem to take the latest research into account.

Also, second the CBT rec. it is very good and worked well for my PND-OCD but it is a hard slog (sorry, I wish it wasn't and I could tell you otherwise).

Lots of HCP will tell you, you will feel better if you stop bfing, and you may well or you may not only stopping will tell you that and by then it might be too late to restart. What I found that kept me with my children was bfing them. It was the only thing I could do for them that no one else could. Bfing made me their mother when I would have given them up and done something stupid.

I had PND-OCD which centred around preventing harm from befalling the DDs - unfortunately a 'friend' put in my head that bfing was harmful past 6m (which it's most certainly not but that played on my mind a lot) but bfing helped me bond with my babies and kept me with them IYSWIM.

None of these comments are a judgement on mothers with PND who chose to ff, just what I found in my situation to help so please don't think I am judging what other mothers may/may not do.

I really hope you get some help whether it is pharmaceutical or talk therapy or both. Good luck and be kind to yourself.

Thanks for that. Yes i've just started CBT and i'm getting support from my hv, gp and a mental health nurse. Like you i think medication is a temporary short term solution while i work on the other issues x

I have been on sertraline since Dec 2006 but I have OCD as well as PND & PND-OCD (surprisingly all different conditions) and sertraline is good at managing OCD, so I keep taking it for help in combating OCD behaviours (I dread my DDs picking up on my 'things').

For ordinary PND, I think a short term course of anti-ds can help and wouldn't be needed for more than a pick-you-up.

I wish you well and hope you have a great Xmas (in as much as you can with PND)

Thanks Truthsweet. Any side effects from Sertraline? I used to take Citalopram and it workede well for me but it's not compatible with bf. My pnd is not ocd related. I'm very tense and irritable with a tendency to lose my temper quickly also very weepy. How long does Sertraline take to kick in?

Sertaline has pretty horrible side affects for the first two weeks. A lot of people develop stomach cramps, headaches, nausa or dizzyness. The side affects subside when your body gets used to the drug. You will also experience side affects when you come off the drug.

It may well be worth asking your GP to start on a half dose and work up to a proper dose.

Sertaline does work, but you do have to ride out the first week or two.

I take citalopram, been taking it since about the middle of my pregnancy (when fluoxetine didn't work), and am still breastfeeding DS at 16 months. No ill effects for him at all.

The most helpful place I found to visit was The Breastfeeding Network and looking at the drug information fact sheets. The pharmacist who compiles the information also runs a helpline, normally you leave a message and she calls you back, but I've gotten to her directly once as well. Her name is Wendy and she is brilliant, calm and reassuring.

I didn't really have any side effects from sertraline but did have a major dip in depression level once I started the meds (known side effect and you have to just drag yourself through it ).

I started on 25mg and take 100mg now with increases very slowly introduced over about a month (25mg to 50mg over a month not 25mg to 100mg!). You have to watch for sedation in baby though and I took the sertraline just before the last feed of the day (or the first of night depending on how you look at it).

Apparently it is quite good for general depression too but I'd do some research into what you think would suit you best so when you go back to Dr you can have some input into what is prescribed.

Try to stay away from drugs like Ambien (sedative which gives you a cracking hangover if woken from sleep [not at all likely to happen with a baby ] which one psych. wanted to prescribe me) or any drug which says 'don't bfeed for X hours after taking' unless you can guarantee that baby will not want a feed in that time frame (e.g. baby always sleeps through or you ffed at that time of day).

And, second Yank's rec. to speak to BFN's Wendy - she is fantastic and has helped me enormously in the past.

Thank you both very much. Sertraline sounds a bit scary. I took Seroxat many years ago with similar side affects. I can't really imagine looking after a baby at the same time as dizziness and nausea... But if ultimately it works then it must be worth it. YankN I was on citalopram when pg but at 7 months my gp suggested i come off it as new research showed evidence of it crossing the placenta. I found it difficult to come off and was still taking it after ds was born. I saw my gp again and again she urged me to come off it as it comes through in breast milk. This is new research apparently but it's interesting that you've not had the same advice. I don't think gp's always know what they're talking about. Ideally I'd like to go back on Citalopram as it really works for me. I'll take your advice and contact the Breastfeeding Network and let you know how i get on. Thanks again x

crossed posts. Thanks truthsweet x

harold, please do come back and tell us, I'd not heard of any new research like that on citalopram. My psychiatrist gave me some information as well indicating citalopram isn't the best, but it's certainly not the worst. It depends how you look at the risks I suppose. If I didn't take this, I wouldn't function at all, and that would be no good for DS.

To be honest Yank I'd sooner listen to a psychiatrist than a gp. They're far more clued up. My gp was getting her information from a book and online. Will certainly keep you informed x