HELP PLEASE-NO LET DOWN SINCE STARTED ANTIDEPRESSANTS

[mothernature1]

Hi,please please can anyone tell me if they have experienced anything similar.I have always had a really strong let down reflex, and as such have collected vast quantities of milk from the opposite side to that which I am feeding on.I also find expressing easy because i just stimulate my breast with the pump and wait for the enormous let down which is like a burning in the opposite breast.
My baby is 6 months old and fully breastfed.I now work 2 days a week and express twice a day at work. For the first time in my life i am on medication for ocd ( obsessive compulsive dosorder ), which Ive always had a tendancy towards, but has got way out of hand since ds was born.I started on 20mgs of CITALOPRAM ( CIPRAMIL ) on Tue.I know Im not imagining it but my let down reflex has literally dissapeared.I take my tab at bedtime, and have no feeling of any letdown until about lunchtime the next day.I also no longer leak from the other side during feeds.Sorry to be crude, but i know one side effect is inability to orgasm, and i was wondering if it was connected in any way-( reduced muscle contraction in the nipple ).I cant decide what to do.Will the effect become total in a couple of weeks ? If not i could take my tab earlier and by lunchtime the next day i will feel my let down to express at work .Or do I come off what otherwise seems such a fabulous medication so i can enjoy breastfeeding without worrying.Has anyone had a similar experience ?

Hm, just because you don't feel the letdown doesn't mean that your baby is not getting enough milk - some women never feel let down at all. Is that your concern, or is it that without a copious and obvious letdown it is more difficult to express?

Oakmaiden,it is definately more difficult to express, but also i feel my ds is having to work harder too for his dinner ! I dont mind not feeling the let down as long as i know my ds is not going without.Will being on this medicine reduce my supply ? And thanks for your reply.

MN1, The breastfeeding network says
"Citalopram (Cipramil) - has a half life of 36 hours and reaches a peak after 2-4 hours. The milk plasma ratio has been estimated to be 1.16-3, suggesting that the drug concentrates in milk. The metabolite enters breastmilk in low levels and at a normal daily intake would produce 14.6mcg/Kg/day (0.7-5.9% of the maternal dose). There is one report of an infant exhibiting "uneasy" sleep patterns on a maternal dose of 40mg/day. This resolved when the mothers dose was reduced. There are also two reports of excessive somnolence, decreased feeding and weight loss in breastfed infants. In studies no adverse effects on the babies were noted. If the baby shows less than expected weight gain it might be prudent to discontinue the drug and change to another SSRI. It should not be given concomitantly with erythromycin or fluconazole."

(Fluconazole is the active ingredient in diflucan and similar so if you have thrush, check with your GP)

Have you checked Hales also?

I thought cipramil was associated (rarely) with a fast let down, but I might be muddled with something else

Wow-thanks Lisa78.What you have told me is quite reassurring.What do you mean by Hales ??? And thanks again.

I think Lisa means Dr Hale if you go to his forums and have a look. I hope you start feeling better soon.

Hi Mothernature, I am a BF counsellor but your question was one I had never encountered so I have asked my more experienced colleagues.... here are some thoughts :

Orgasms and milk ejection reflex are BOTH linked to oxytocyn release so it can make sense that you are feeling a change in both areas. SRIs are going to have an effect, direct or indirect, on the posterior pituitary gland and the hypothalamus, it's almost certain that the oxytocin secretions would be likewise affected.

It is interesting to see that an SSRI has been prescribed for a bf mum given that they are not prescribed for children. One of my colleagues believes they have now officially been banned for use in children...so how come it's okay for a bf mum to pass it on via her breastmilk...?

Also in Hale it says the adult concerns with Cipramil are: diarrhea, headache, anxiety, dizziness, insomnia, constipation, nausea, vomiting & tremor.
If you have diarrhea and/or vomitting for example, dehydration could be affecting things. Or extreme anxiety?

If you contact me - I can put you in touch with very experienced BF counsellors who have much more info on this very topic.

But pupuce, nearly every single b/f mum on this site on an AD is on an SSRI, some of them, like Lustral, aren't detectable in the babies blood. Or did you mean Citalpram in particular? Or is there some other info you mean? I'm confused!

pupuce-have sent you an e mail.Would really like to talk to you or you collegues.Am at a loss as to what to do because i absolutely know its the citalopram.Will all antideppressants have the same effect on me.Would so appreciate a chat. And thank you.

Pie, don't worry, you know that lustral (aka sertraline!) is considered safe for breastfeeding mothers - no it isn't prescribed for babies of course, but generally there is interest in whether drugs pass into the breastmilk and hence to the infant - the old TCA AD did, tho impact on the baby was not considered significant.

The SSRI's are newer and considered safer and effective much faster, but because clinical trials in lactation have either not been done, or have been done on small scales we don't have quite so much information on these. I haven't heard anything about banning SSRI's for children either. There is a distinction between children taking a drug and it being passed on thru the milk anyway - besides, sertraline is detected in infant plasma only rarely and then at extremely low levels.

Please don't worry, you aren't doing any harm on this AD and b/f too, really you're not.

Pupuce, there are many ways in which a drug that would not be prescribed for infants might be safe for a bf mother. Hale's book outlines the reasons - it depends on biochemical stuff like how easily or not the constituents of the drug bind to plasma, or to fat; whether the digestive juices destroy the ingredients; the half-life of the drug (how long it stays around in the body).

I think your colleague has been thinking of the recent controversy about certain SSRIs which have been prescribed for adolescents and which have been linked with an increased incidence of suicide. As far as I recall they have not been 'banned' though.

Not feeling let down may not be an issue. Plenty of mothers never feel this, or if they feel it, they stop feeling it when bf is well-established. Smaller volumes when expressing is also a common issue, and this can be remedied by more frequent expressing. The reasons why mothers who are well-established breastfeeders may start to get less with expressing are complex - I have my theories - but it is not significant if the baby is getting what he needs. Anyone can raise their supply by feeding more often, at any time.

Is it possible you are watching for these apparent effects and linking them with the medication, but in fact they have happened co-incidentally??

Hi - all SSRI's except prozac have recently been banned for under 18's.
(Gp's cannot now prescribe them unless its a severe case which has been referred to a consultant psychiatrist. The psychiatrist must then prove that the potential benefits outweigh the potential risks.)

Mothernature1 - please dont worry about this as part of your own situation. The amounts passed on in breast milk are minute compared to the doses taken by teenagers.
You can always have another chat with your GP too to get double reassurance.

Hope the cipramil starts to work for you soon.
Kizziex

Hi,thanks everyone for your feedback.It was reassurring at the time.Youll be pleased to know my "let down " came back with a vengence yesterday.Must have been just while my body got used to the new med.Initial dizzyness gone too and feel better already-not cleaning 24/7 which is leaving me with so much time to enjoy my ds !

mothernature1 - I remember experiencing changes in feeling my let down reflex at around 6 months with no drug intervention. I think it's as tiktok says and to do with b/f finally being established.

on another note, I'd really like to talk to you about ocd, but don't want to pry. So if you fancy emailing me, please do?