breast feeding on anti-dipressants??

[talktalktalk]

i am now in my 28 th week of pregnancy and taking sertraline (25mg every other day ) i have been told i need to wait and hear from a specialist but chances are i can't breast feed on it. i have looked in to it and every where you turn there is a diffrence in opinions!! has anyone else had to deal with this? and if so what was the out come?? xx

talk hope you get some good info and advice. Sertraline and breastfeeding is not usually thought of as unsafe - "It is normally seen as the SSRI of choice for a breastfeeding mother" according to Breastfeeding Network's evidence-based drug factsheet www.breastfeedingnetwork.org.uk/drugs-in-breastmilk-information-and-factsheets.html

"Most authoritative reviewers consider sertraline one of the preferred antidepressants during breastfeeding" according to this respected website, too toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT

Anecdotal but I have bf for 5 years on Sertraline (doses varying from 50mg to 150mg and used as an anti-OCD drug as well as an anti-depressant) and I am on an anti-epileptic as well.

As tiktok says it is normally seen as the drug of choice (it's the most recommended drug out of the most recommended class of anti-depressants for bfing mothers) and there may be reasons why in your particular circumstances that make it non-compatible with bfing but generally speaking it is compatible with bfing.

If you have concerns as to your individual situation and this medication you can contact Wendy Jones (the pharmacist who wrote the factsheet tiktok linked to) at the Drugs in BreastMilk Helpline.

This is from the information sheet for sertraline "Use in nursing mothers is not recommended unless, in the judgment of the physician, the benefit outweighs the risk."
. But it also says that no studies have been done to show whether it is safe or not, so this could just be a covering their backs policy.

this website has information sheets (both the ones for patients -pil, and med. profs. -spc) for lots of drugs www.medicines.org.uk/EMC/

The information sheet that came with the drug or its packaging should have the name of the company that makes them, you could try calling their helpline.
But your best bet may be to just speak to the specialist, they will deal with this situation a lot and are probably the best placed to give you advice.

From the LACTMed link (the US database of all studies on medicines and bfing) says this about sertraline:- 'After a constant maternal sertraline dosage for at least 14 days, infants had their serum concentrations measured. The infants were an average of 5.9 weeks old at the time of serum sampling. Sertraline was not detectable (

The BNF, and the spcs are the latest up to date information on drugs and their side effects. It would be reckless to advise someone to ignore it. OP,
contact the manufacturer, and the drug regulator of the country you live in for their advice on the drug.

thank you all so much for your feed back :) it's hard to know the right thing to do, but i think i will push to brest feed as it seem's there is no conclusive evidence to say i can't. i will speak with the specialist but the more i find out the more i think breast feeding on such a low dose should be ok. xx

If you have Ante-natal depression there is a higher risk of Post-natal Depression but it's not a cast iron guarantee of it (luckily). If you had depression prior to pg then I'm not sure if there is an increase risk of PND or not ('probably' says the depressive in me!).

Have you seen any of Kathleen Kendall Tackett's research into PND? It makes for some really interesting reading - her website. She's done a lot into bfing with depression (in the US it's called Post Partum Depression not Post Natal for some reason!).

Good luck with the rest of your pg and if you do decide to bf (with or with out meds) then do investigate the local bfing support groups (we always love having mums with 'bumps' along) before baby is born - it's much less daunting that way and if you don't feel up to venturing out, they may be able to do a home visit.

I'm just going to throw in a curve ball here.. I don't take your AD.. I take a different medication, but I was advised to not BF on them. Nothing to do with the medication and the effect on my little one but as a method to keep me sane.

My gp was concerned that I would suffer with the exhaustion that comes with BF. She also felt I would put too much pressure on myself because I would be the only person to feed him etc. These are my triggers for depression. This is why she suggested I bottle fed.
I did try BF but it didn't happen for me (LO ended up in hospital but that's another story!) so we were forced to bottle feed him. I did feel really guilty at the time but 8 weeks in (and talking to other BF mothers) I can see the point my GP was making.

sorry if that's not any help!!

katy

I've suffered with depression for many years, I stopped taking my normal ADs while I was pregnant (Prozac) and I felt very low for most of the 9 months. I was referred to a specialist Mental Health Peri-natal (?) nurse and we discussed breastfeeding and ADs, since I was desperate to go back on them. She said that sertraline is actually the AD that is recommended for bf mothers, as it doesn't go into the milk. So you should be able to stay on it.
I think Katy makes a very good point above, I think also my risk for PND would have been much higher if I had breastfed because of the reasons she mentions. I didn't intend to ff my DS, but it ended-up that way for other reasons, and I reckon it's been the best thing for us; I am coping (reasonably well) and able to go back on my ADs which allow/help me to be the best mum I can be. At 13 weeks he is thriving!
Of course bf is the best thing for your LO, but remember to look after your own mental health. There is another option and it has worked well for other Mums.

Can I also just say that if there is no conclusive evidence it is unsafe there is also no conclusive evidence it is safe - would you take a drug yourself if someone told you there was no conclusive evidence it was safe for you?
Also it is important not just to assume that a low dosage is ok for a child. Children are not just little grown ups they metabolise and process drugs differently to adults, which is why you see dosage advice based on the age not weight of children.
I really would advise you speak to your specialist (who should know about the particular drug), the manufacturer, and the drug regulator in your own country. Also the BNF and the spcs will contain the most up to date safety advice for the drugs.

Kelly thats the way medicine works. They look for evidence of harm and unless they find them, it is broadly presumed safe. Pretty much everything we do has a risk attached to it, its whether the benefits outweigh the risks. Not treating PND also has risks for a baby - these are well known and documented.

I had antidepressents when breast feeding (am afraid I can't remember which) but there was a fairly limited choice that are reommended for breast feeding mums.

Tilder,
I would still speak to the actual specialist, the manufacturers, and the drug regulatory agency in her country. They are the people who make, license and look at the safety of the drug.

kelly, you have an agenda, but sadly little knowledge.

Drugs are researched from the point of view of doing harm.

It is not possible to research and 'prove' something is safe. You can show by research something does harm, and show absence of harm - but absence of harm does not prove safety. This is where understanding how a drug works would come in. So if it's known (for example) that a drug's molecules are too large to enter the milk, then it would be ok to infer its safety - but you could not really 'prove' that. Or you could see that in a sample of milk, the active ingredient of a drug was there in a tiny microscopic quantity only, you could also infer, without proving, that it was safe for the baby.

The specialist you urge the OP to speak to may have a view and of course should be consulted. But he/she may not be an expert in pharmacological interactions with breastfeeding and babies. The manufacturers have a cover-your-ass approach, which may well mean they advise 'no' with no real evidence. The drug regulatory agency in the UK is here: www.mhra.gov.uk. They look after licensing - I doubt they would take individual queries from the public, but in any case, sertraline is a licensed medication and it would be up to the prescriber to discuss its use with the patient (in this case, the OP).

The OP can look at reputable websites and other sources and take advice - and then decide.

I agree that I would speak to the specialist, who really should know what drugs to prescribe - generally the GP but worth checking which GP at the practice is best for this (and our GPs sometimes will discuss pros and cons as a group before prescribing to a pregnant/breastfeeding mum). Not convinced about getting much info from a manufacturer. The info from the drug regulatory agency should be with the specialist, but worth a check if you are concerned.

Am not suggesting that she shouldn't check first (she would have to anyway, since these drugs are prescription only) just that there are risks in not taking a drug as well as risks in taking it. If that makes any sense at all

Thanks tiktok you explained the harm/absence of harm much better than me!

tilder, you make a good point about untreated depression and its affect on the baby. Large body of evidence on this.

Also, something we have not commented on, OP: you are already taking sertraline. Generally (not always, and I have no idea if this is the case with sertraline), babies in utero get more of a maternal drug than breastfeeding babies. So if something is deemed to be safe in pregnancy, it's usually as safe if not 'more safe' during bf :)

tiktok,
No I do not have an agenda, and you do not seem to know a lot about drugs (seriously you think you can infer that if something is a small does it is ok for children). The drug regulatory agency of whatever country the OP lives in is the best place to get advice, they take into account every study done on drugs both pre and post marketing. The MHRA does take queries from individuels - they have a specialist helpline if you look at their site, and they do deal with the side effects and safety of the drugs not just the licensing. You are incorrect to say they only deal with licensing.

You are being very unfair to claim that anyone who suggest the OP takes advice from the people who are actual experts on the drug and how it metabolises has an agenda. The OP should consult specialists for advice, and it is very difficult for an individuel to ascertain how reliable random websites are. medical specialists are used to dealing with pregnant and breastfeeding women, so it is unfair to claim they know nothing about it. If you look at my comments I do not encourage people to not bf or vice versa. Those that encourage people to ignore specialist advice and only look at websites telling you sertraline is safe when bf-ingcome across as having an agenda.

Drugs are not just researched from the point of doing harm, they are also researched from the point of doing good -that is how the drug comapnies can get their licenses extended.

And a doctor cannot just say that if they took it during pregnancy it is ok to take when bf. A HP has to look at the risk benefit, so whilst the OP was pregnant the HP may have felt withdrawing the drug presented too big a risk, but they might equally feel that breastmilk with sertraline presents a bigger risk to a baby than formula milk. Or they may not.

Tilder,
if the manufacturer is based in Europe it will have to keep reports on any negative issues to do with the drug, and it should have an advice line where they can tell you if it is recommended for use in breastfeeding.

kelly, I said 'you could infer something was safe for babies' - the use of the conditional auxiliary means this might be possible, not that it is every time.

And indeed it might be. Don't sound so outraged. I am right about that. It's on this basis that decisions about safety are made - check out the LactMed page about sertraline for an example. It's partly because only very low levels of this drug are found in breastmilk that it is deemed to be safe.

I didn't say the MHRA only dealt with licensing - I identified it as dealing with licensing because that was the question at issue. Yes, it deals with side effects and safety - those issues are part of licensing anyway. I am surprised that an individual can call them with queries about their own situation and cannot find the helpline you say is there, but I could of course be wrong about that :)

I did not claim medical specialists know nothing about breastfeeding - you are seeing things, you really are! I told the OP that her specialist might not be a specialist in pharmacology and breastfeeding - and of course I am right in that!

I did not say the OP should ignore specialist advice. Quite the opposite - she should seek it out, and take it on board and also do her own research using the reputable links posted here. It would be a good idea for her to share her findings with the HCPs caring for her, too, but she is clearly going to do that anyway.

I did not say the doctor can say if she take it in pg then it's ok for bf.....I really did not! I explained that in general, the baby gets more of a drug when in utero, and by implication, this would be something she could take into account when deciding and discussing.

Please stop putting words into my mouth.

I don't think 'anyone' saying what you are saying has 'an agenda'. But you have, for sure! Your agenda is that it doesn't make much difference if someone breastfeeds or formula feeds (you own words elsewhere)....that's an agenda.

I sat through a brilliant presentation yesterday by a neo-natologist called Dr Neil Aiton who was happy to have mums bf on methadone, SSRIs inc. Sertraline which he said was one of the best choices for a mum with PND (apparently there is a theoretical risk of SSRI withdrawal post birth but he has only seen one case and then the mum was on a cocktail of 3 different anti-depressants).

If you are anywhere near Brighton or Haywards Heath and you are still worried about taking Sertraline and bfing (or possibly anywhere in the SE as he will see anyone in his drop in clinics) you could go and see him. I doubt very much he would have any problems with you taking it unless there is other information which you haven't shared with us that would contra-indicate bfing (and you certainly don't have to share your medical history with the web!).

He explained why drugs aren't tested on bfing women (usually drugs are tested on dogs and med. students and not necessarily in that order!) as they would have to find enough bfing women with that medical condition (which would be difficult as they would all have to be new mums not bfing 3y as the amount of drug to body size would be miniscule).

Tbh they can analyse the drug by looking at the molecular size of the drug, the milk:plasma ratio, the rate of protein binding, the oral availability of the drug (can it be swallowed or only injected), etc, etc, without it even getting near a newborn.

Even with out testing Insulin, they know it's safe for bfing mums - molecular size is 6000 (300 is the thresh hold for getting into bm) and it has to be injected (no insulin tablets can be made) so what problems could there be?

OP,
Like I said before speak to your specialist (or even a pharmacist who speacialises in anti-depressants), the manufacturer (they should have an advice line, and all the information regarding negative reports about the drug since it went on the market), or the regualtory agency of your country (The one in England is called the MHRA and it does have a patient helpline, plus you can get information from its website). The regulators like the manufacturers are required to keep records of all negative reports made about the drug since it was released on the market (not just those to do with licensing it), and they will also base their information on all studies not just one. To be honest i woudl also suggest that if you get information from anyone other than your specialist that you speak about the information you find with your specialist anyway. perhaps make sure you have a list of questions, and resources prepared when you next go to see her.

Tiktok,
Please learnt he difference between an agenda and an opinion. You seem desperate to get validation about your choices by insisting that everyone agrees with you and thinks your choices are the best for them too, and that anyone who does not do what you do is part of some sort of anti-bf conspiracy. Considering I have never advised anyone to ff or bf, but have suggested people speak to BF counsellors and support groups if they are finding BF difficult, and suggest peopel speak to HP when wishing to know if bf is safe on sertraline, i am not sure how you consider my actions to be part of an agenda, unless you really are paranoid and/or insecure.

kelly: you say "You seem desperate to get validation about your choices by insisting that everyone agrees with you and thinks your choices are the best for them too"

No idea where you get that from! You have no idea what 'my choices' are. I don't care if people agree with me or not, as long as the discussion is informed.

" and that anyone who does not do what you do is part of some sort of anti-bf conspiracy."

Ditto - that comes from nowhere.

" i am not sure how you consider my actions to be part of an agenda, " - in that case, I will tell you, shall I? Your actions are part of an 'agenda' that does not value breastfeeding (you don't think it makes any difference whether a baby is bf or ff) so it follows that you stress above all else sources of info which will tend to advise that a bf mother cannot take sertraline (the specialist, the manufacturers, the licensing authority), rather than sources of info which actually assess the evidence after thorough study and no other motivation.

What - you think anyone who says speak to a specialist, or the agency that deals with drug safety in your country is part of an anti-breast feeding campaign, and that specialist and the agencies that regulate drugs have no through knowledge of how the drugs work, do not look at the evidence thourghly, and have some sort of secret motivation when it comes to bf!!!!!

My opinion if FF is no worse than BF after the first few feeds (meaning I think BF is better for the first few feeds), but that does not mean I am anti-BF or pro-ff. As you can see I have never told anypne what to do, and I have advised people speak to bf support groups. If you think differently that is your choice, and I would never try to persuade you otherwise, so long as you do not attack me in order to validate your own choices, as I am secure in my choices. You seem to be telling people to ignore everyone apart from pro-breast feeding groups.

To actually saying that people should not speak to specialists because they might possibly say do not BF whilst taking the drug is wrong. medical specialist and regulatory agencies (there is no licensing body, just regulatory agencies that also deal with licensing as well as the safety of the drugs both pre and post marketing) have no motivation either way when it comes to BF - you are sugesting they give out advice to stop bf for the sake of it. then you wonder why you come across as a paranoid conspiracy theorist, who is so insecure in their parenting choices everyone has to agree with them in order to get validation.

You are making things up, kelly. I am out of here now.

"you think anyone who says speak to a specialist, or the agency that deals with drug safety in your country is part of an anti-breast feeding campaign, and that specialist and the agencies that regulate drugs have no through knowledge of how the drugs work, do not look at the evidence thourghly, and have some sort of secret motivation when it comes to bf!!!!!"

NO!!! I don't think that and I did not say that! You are utterly bonkers (and I mean that in a nice way ) saying I said that!

You stressed only sources of info which are likely to advise against bf with sertraline (not because they are part of an anti-breastfeeding campaign, FFS, but because of other reasons) while other posters added other, reputable, sources of info to consult which use other means of assessing risk and safety.

Of course the OP should speak to the specialist (and the manufacturers and Uncle Tom Cobbley and all) - and she is doing that anyway.

You are quite, quite paranoid, you really are....

An I did not say you were anti-bf or pro-ff.

I said you did not think bf/ff made any difference - that's not being anti- or pro-, just ill-informed :)

OP, do listen to tiktok, she is the voice of reason.

Lots and lots of people BF on sertraline, me included, after making an informed decision based on available evidence.

For what it's worth, phoning the drug manufacturers will be worse than useless - they will say 'no' for reasons of risk avoidance.

Breastfeeding may be important to your mental health. Or it may not. Only you can answer that one. But if it is, then it may be better for you + baby to be on a drug and breastfeeding than depressed and not.

It's also not inevitable that people who breastfeed get worse sleep than those who bottle feed. My worst sleeper by far was formula fed.