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Infant feeding

Get advice and support with infant feeding from other users here.

bfeeding, PND and anti depressents, URGENT advice wanted please

82 replies

4madboys · 15/07/2008 15:15

hi i am posting this on behalf of a friend, she is bfeeding her 7mth old, who is pretty much exclusively bfed, (doing BLW) and she has been suffering from quite bad pnd, feeling suicidal, unable to cope etc.

she has been backward and forwards to her gp who have been useless pretty much.

she went again today and they have said she MUST stop bfeeding and start taking citalopram and she is on the 'waiting list' to see a psychiatrist oh and she can have counselling if she pays for it....

she REALLY REALLY REALLY DOES NOT WANT TO STOP BFEEDING, is absolutely gutted, so i said i would ask here and see if this medication is ok with feeding or if there is an alternative, and get her some advice that she can take back to her gp.

so please help

OP posts:
4madboys · 15/07/2008 22:20

no its not a high dose, i have checked that.

and yes she is in a bad way and stopping bfeeding will make that WORSE.

OP posts:
Pannacotta · 15/07/2008 22:21

YOu're a real charmer Nancy....

tiggerlovestobounce · 15/07/2008 22:21

Can you show us some evidence that 50mg would be dangerous for breastfeeding?

TinkerBellesMum · 15/07/2008 22:22

The specialist (M&B) psychiatrist I've seen put me on Citalopram after a very long fight (2.5 years) because of being pregnant or breastfeeding, I wouldn't have gone on anything that wasn't suitable and they knew that.

My understanding from the hospital is that the only drugs that they would say not to breastfeed with are the major anti-psychotics or AD's that only they can prescribe. Citalopram is one of the generic drugs GP's give out.

I accept that ringing the Practice Manager might not work, I know people who have done it though for someone who was too ill to really deal with the complaint them self. The best thing would be to accompany her on a visit.

I'd like to point out that GP's don't know everything. My GP told me to only take painkillers for my back in the morning after I'd fed Tink and not to feed her during the day afterwards. I later found out it is given to mothers following a CS. Was slightly peed off for all the times I was in agony but didn't take them because Tink was having a fussy day that normally leads to her wanting more feeds.

Nancy66 · 15/07/2008 22:23

No, i can't show you any evidence. i'm not a doctor and therefore i would never over rule the advice of one without being sure of my facts.

TinkerBellesMum · 15/07/2008 22:23

Yes please, evidence! For the short time I was taking it I may have harmed my daughter

4madboys · 15/07/2008 22:26

but there is evidence quoted on this thread to show that it is ok to take nancy.

and like you said you are NOT a dr, my friend wont just follow this advice willy nilly, she will take it and show it to her dr and to her psychiatrist.

and if i hadnt of questioned medical advice given to me by a dr i would be dead, they really arent gods and do get things wrong you know.

OP posts:
ChukkyPig · 15/07/2008 22:26

Nancy what is your evidence that it is a bad idea? Just that her GP told her not to?

TinkerBellesMum · 15/07/2008 22:28

According to LactMed, all studies on Citalopram were done on doses with varying starting and minimum 50mg at the high end, some even went up to 60mg. They still say Citalopram is not a reason to discontinue breastfeeding.

How much studying do you think a GP has done on breastfeeding?

I know around here if we're lucky our GP has completed a 5 day course on support, nothing in it about drugs however, just how to support a mother.

Nancy66 · 15/07/2008 22:32

yes, thank you, I know GP's aren't gods there are some fantastic ones and some shockingly bad ones.

this doctor on Netdoctor seemed to think Citalopram and BF is not a good idea:

I am sorry to hear of your post-natal depression and thank you for e-mailing on the problem of anti-depressants and breastfeeding.

Clearly, if you can find a medication that suits you and is considered acceptable when breastfeeding to you and your doctor, this would be best for you and your baby.

You are correct in your assessment that I am unable to advise you to continue breastfeeding while on Citalopram. The same advice stands for fluvoxamine and fluoxetine, both anti-depressants in the same group.

Sertraline however, is not known to be harmful in short-term use, although there is 'insufficient data on long-term use'.

How one would define short-term use would require further clarification.

With paroxetine, an anti-depressant in the same group, the manufacturer advises 'avoid unless potential benefit outweighs possible risk'. This judgement of course is a matter for your doctor to decide having assessed your condition.

The majority of anti-depressant therapy is known to be excreted in the breast milk.

The older, tricyclic antidepressants are said to be found in the breast milk in amounts 'too small to be harmful', but most manufacturers advise doctors to avoid prescribing if the woman wishes to continue breastfeeding, because of potential risks to the baby's breathing.

One's reaction to anti-depressant therapy is often very variable according to the treatment.

If you have found a preparation that suits you, your doctor may feel it best that you keep on it and discontinue breastfeeding.

A compromise could possibly be reached with one of the preparations mentioned above, and breastfeeding may be able to continue, but this is for you to discuss with your own doctor.

I sincerely hope that your family life soon becomes easier and happier.

expatinscotland · 15/07/2008 22:36

Nancy spent some time on Google digging that one up!

tiggerlovestobounce · 15/07/2008 22:36

An unlinked cut and paste of unspecified age giving advice that would today be regarded as out of date?
Is that all you could find

expatinscotland · 15/07/2008 22:37

and weighing up how badly a woman's PND will be affected by abruptly stopping BF v her medication (and let's face it, this doctor could have located the best one for her with a point nad click or a brief phone call to a consultant psychiatrist) is part of the JOB of a good doctor.

TinkerBellesMum · 15/07/2008 22:38

Was that a Mother and Baby Psychiatrist that wrote that?

Nancy66 · 15/07/2008 22:38

Fuck me - it's a year old - from netdoctor.

actually there were others too but I can't be arsed - you clearly are the experts after all.

expatinscotland · 15/07/2008 22:39

bbaaaaa.

bbaaaaa.

here is the surgery. here is the steeple. open the doors, and see all the sheeple.

tiggerlovestobounce · 15/07/2008 22:40

You dont know if people posting here have expertise or not, which is why most people reference the claims that they make, rather than expecting others to take things at face value.

ChukkyPig · 15/07/2008 22:51

Yes Nancy, but the quote you have taken basically says "no comment" on the drug in question. As trials with breast feeding mums are a bit rare (can't think why) they tend to all say "no comment" "not advised" etc.

The amount of whatever the mother ingests is much more than the baby gets through BM. The way I heard it was that BM is the same concentration as your blood concentration, which for these drugs would be minimal.

I suspect the effect on the baby of having BF withdrawn suddenly would have a far worse effect than a very very small dose of some AD coming through in the milk.

bearmama · 15/07/2008 22:52

According to my Doc (who is decent and does her research) the only AD for BF is Sertraline.
I have depression, I'm on it and I'm BF. I would be gutted if I had to stop.
4madboys, your friend is lucky to have you - hope she gets the help and support she needs.

TinkerBellesMum · 15/07/2008 23:17

bearmama, as I said before, I'm under a M&B psychiatrist and they know my stance on drugs, I also looked it up on LactMed which quotes a lot of studies that all have shown it to be safe.

My GP looked up the painkiller she gave me and told me I needed to not BF after taking it, I then found out it's used for women for post-section pain relief. Even the best of doctors can be too much on the side of caution.

tiktok · 15/07/2008 23:24

Nancy, nothing you have said (not even Dr NetDoctor) contradicts the basic suggestions here that the doctor is being overly dogmatic, that there are other opinions and other research on this issue, and that it is worth looking at the research and thinking of alternatives...and it appears this particular GP has not looked at them.

What on earth is 'dangerous' about saying that?

tb73 · 15/07/2008 23:44

Has your friend has her Thyroid tested? Over active Thyroid can give the same symptoms/feelings as depression and even psychosis. It is also more common after pregnancy.

I have read up on this only this week so you can take my word for it!

I hope she gets the help she needs - the days when Doctor knows best are long gone.

LackaDAISYcal · 15/07/2008 23:56

I think GPs open up the BNF, see a drug isn't licensed for BFing then tell you not to BF whle taking it.

However being unlicensed for BFing is not the same as not being suitable for BFing and it becomes a judgement call for the doctor in question whether or not to prescribe it. Getting licences for use in BFing is a very lengthy and expensive process and there aren't many parents who would gladly sign over their children for the trials that need to be done.

However some of these ADs have been around and have been used in BFing long enbough for the health professionals who are prescribing them to be confident about their use.

And I know we are none of us professionals on here Nancy, but our collected anecdotal evidence is surely worth something, at the very least to help this woman know that she is not alone and that she can get the right tablets and continue to breastfeed. My HCP is Dr Narayan, consultant psychiatrist at the Leeds Perinatal Mental Health Service if you need to check credentials.

vonsudenfed · 16/07/2008 00:08

Nancy, read the links I posted very early on.

They are the research studies on ADs and breastfeeding (the Kellymom one links to supporting papers). They are referenced medical studies - unlike the opinion from netdoctor. It is very clear if you read these that there is almost no evidence of Citalopram causing any harm, other than two incidences of sleepiness in newborns. By 7 months, there is no evidence of any ill effects.

Believe me, I am a researcher by profession, and I would not have taken Citalopram while bf unless I could prove to myself that it was safe. I didn't believe the doctor alone when she said it was.

4madboys · 16/07/2008 01:17

thankyou ladies, my friend and her dh have looked at the links and done a bit more research and she is going to carry on feeding

she will feed a bit less, purely so someone else can take the baby and let her get a bit of rest, but she is feeling much happier now she can continue to feed

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