breastfeeding and escitalopram for PND

[mumof1]

Finally admitted defeat and went to my GP today. He has prescribed me escitalopram for PND. I specifically asked whether I could continue breastfeeding and he said yes but I have got home and Googled and all the articles say you should not breast feed. I've lurked on mumsnet since I've been pregnant and it usually has a post that answers my question but I can't find any reference to this AD.

I was reluctant to take ADs anyway, but now I am even more convinced I don't want to. My son is 16 weeks old and fully breastfed and I am aiming for the full 6 months.

Does anyone have any experience of this drug whilst b/feeding and was it any good?

Thanks for any advice

Most drug literature say you should not breastfeed while taking them, just to cover the drug company. In practice, with most commonly prescribed drugs very little passes through to the breastmilk, so the actual dose the baby is potentially exposed to will be very small. There's also very little decent research into the effects of individual drugs in breastfeeding.

I have taken a very potent immunosuppressant drug during three pregnancies and breastfed for over a year with each baby. I was told by a consultant with extensive experience of prescribing the drug that the benefits of breastfeeding definitely outweigh the disadvantages, despite all the literature to the contrary. My babies have all been fine.

No experience of your drug, but during my extensive research, found that there are only a very few drugs which are really dangerous in bfeeding, and they're mainly the potent anticancer drugs. I'll try and dig out a US website which has good specific info, but it may take me a little while.

hth for now

You're in luck (well, as lucky as you can be with PND), there was a recent study published in a respectable journal by academics, not drug companies, that is very reassuring. Here is the abstract:

OBJECTIVE: The purpose of this study was to determine the frequency of infantile adverse events from exposure through breast-feeding to maternal citalopram therapy. STUDY DESIGN: This was a prospective, observational cohort study. Women who were breast-feeding were placed in three groups on the basis of citalopram use: group 1 consisted of 31 women who were depressed and were undergoing citalopram therapy, group 2 consisted of 12 women who were depressed but were not undergoing citalopram therapy, and group 3 consisted of 31 healthy women who were matched to group 1 by maternal age and parity. Data collection included infant feeding method, medication use, and adverse events. RESULTS: There was no statistically significant difference in the rate of adverse events in the three groups (3/31 events, 0/12 events, and 1/31 events in groups 1, 2, and 3, respectively). The average dose of citalopram that was used in group 1 was 25.3+/-11.4 mg per day (range, 10-60 mg/d). CONCLUSION: To our knowledge, this is the first prospective, controlled study to examine the safety of citalopram during breast-feeding, which should be continued during maternal citalopram therapy.

So I wouldn't worry about it, and get better soon.

This is the website I was talking about.

It's a horrid feeling thinking that bad stuff may be passing through your milk to the baby I had that feeling on and off all the time I was feeding, even though I'd been reassured it was OK. But you're doing brilliantly to be feeding with PND poor you! So I really really wouldn't worry overmuch, and just get better as soon as you can for your baby.

I started on 40mgs of Cipramil (citalopram) when ds2 was 6 weeks old and I continued to breast feed. My GP said that while caution was advised, the drug is not contra-indicated while breast-feeding. My ds2 was absolutely fine, and I carried on bf-ing til he was 8 months old.

Btw, "admitting defeat" is the best and bravest thing you could have done - it's the first step to feeling better. Cipramil helped me enormously and I hope you start to feel the benefits soon. Good on you for carrying on bf-ing and I do hope you feel happier soon. Take care xx

Thanks for all these detailed replies. I've now found some specific information on the website you recommended (thank you frogs) and so I am now really reluctant to take it.

Lexapro(escitalopram) is just the active isomer of Celexa. The breastfeeding data in MMM on Celexa should be identical for Lexapro. We are having increasing reports of somnolence in breastfed babies, particularly young infants. Please watch for sedation.

my GP did prescribe a really low dose (5mgs) and so I think I can't be "that bad", although he did say to come back in a couple of weeks to probably up the dose.

Thanks for all your trouble. I guess I will just stick with the HV coming every week - although I don't think that lowers my stress levels very much!