Breastfeeding and Citalopram (AD) - quick advice needed please lovely MNers!

[galen]

Me agin - so sorry - but youMNers are such a great source of support as I have no RL support!
So last week when I was going to give up BF I went to GP about my diping mood and he prescribed citalopram. Chose this one cause I have had it when I had PPD before and I responded really well to it, with very little side effects and had no trouble coming off it. Now though I have decided to give BF another shot ( see my other posts LOL) so have spent all week building my supply back up and it seems to be going well. I haven't started the citalopram due to deciding to continue with BF. My mood however is not good, and I can definately feel myself slipping back down the PPD spiral.I really need to start on some meds, as I know they will help me out of this black hole. BUT I REALLY don't want to give up BF.
I know there may other better choices of AD's for BF, but I know citalopram will work, and am reluctant to try something else - it took me ages to pluck up the courage to try AD's last time as i'm not keen on medication. But now I know these will work and I can feel better. So from what I have read only a relatively smal ammount will pass to baby. Do you think with timing of the dose it may be possible to take these safely whilst conyinuing to BF? DS now ( miaculously!) has a decent stretch of sleep from 6.30 pm till around 3.30 or 4.00 am so if I took it after his betime feed, would there be much left in my milk by 3.30? Also if he did wake earlier ( like the other nigh he did wake at 10pm caus ehe has a cough and couldn't settle back off so I BF him) would it still be safe to feed him then r should I offer a bottle? And finally will they effect my suply at all?
Any advice would be really gratefully received!

Sorry that post is so full of typos and sp mistakes - must be more tired than I thought - but you get the idea LOL

toxnet.nlm.nih.gov/cgi-bin/sis/search/f?./temp/~nHe9UR:1 would indicate that not necessary to time doses or be that anxious about the effects....IMO. But read it and see what you think

Thanks Tiktok. Great link.Really need to start on them , so will give it a try - seems the worst that can happen is uneasy sleep - so will watch for that! Hopefully he will be fine - he is 8 months now and big, and having some solids (a bit!) too so hopefully there wont be any effect.

i had a chat with a perinatal mental health nurse specialist about this and her opinion was that the risks of a stressed, anxious or depressed mother were much greater than any minimal effect (if indeed there is any effect*) of citalopram on the baby.

• from what I've read, it seems most likely there is no effect but as no specific trials have ever been (or will ever be) done, they can only go on the evidence that plenty of people have taken it so far during BFing and no deleterious effects have been seen to date.

Hi, not a GP but just to reaasure you that I too was prescribed citalopram when breast feeding. I used it for 7 mths & whilst it zonked me out, rather than lifting my mood, DD was fine. My GP was continually reassuring me it was fine to take.

Hope you're feeling better soon.

This covers the range of options for prescribing:

www.breastfeedingnetwork.org.uk/pdfs/Postnatal-depression-and-antidepressant- use-in-breastfeeding.pdf

Of course anti-depressants aren't the only therapy for PND, interpersonal psychotherapy (IPT) or cognitive behavioural therapy (CBT) can be considered too.

Hi, not a GP but just to reaasure you that I too was prescribed citalopram when breast feeding. I used it for 7 mths & whilst it zonked me out, rather than lifting my mood, DD was fine. My GP was continually reassuring me it was fine to take.

Hope you're feeling better soon.

I take citalopram and am breast feeding my 6 week old daughter. I have noticed a few things that I'm not sure are normal ( being a first time mum ) my babies personality or due to the anti D??. They do concern me and more so as time goes on. I have been on the same anti D for years now.
When she feeds especially during the night she often has a real battle with trying not to go to sleep after about 15 sucks, she makes elephant noises ( lots ), wriggles, sqwerms and goes red in the face .. Not to mention takes in air during this process and pulls/stretches my nipple around. I'm convinced my anti D has something to do with it. Some nights it is SO tiring and it can be frustrating Is it the anti d ???????

(Angie mine does this and I think it is just tummy ache / need to suck but does not want milk. Not sure related to the ADs... HTH)

Why would it be the anti-depressants? Anti-depressants may cause things like sedation (sleepiness), or slower than normal weight gain (two of the possible side effects for sertraline which I take) but I have never heard of it causing normal newborn behaviour (which is what you are describing). Sorry!

Doing skin to skin, gentle stroking of her skin to soothe her, 'shhing', rubbing her back can all help calm down a fractious newborn so they can carry on feeding without getting distressed.

Are you feeding her lying down or sitting up in bed/chair?

I feed her mainly sitting up. Thank u for comments. But maybe it IS causing drowsiness / sleepiness. It is like she is FIGHTING to stay awake to get the milk, I can see it in her eyes as the pupils start to get small as she nods off on the breast and them she tries frantically to wake herself!. I've started changing her nappy before each feed with a little stimulation to make sure she is awake and then quite stimulation during the feed to help her wake herself. I figure as she gets older she might be able to get all the milk she needs before drowsiness sets in

Ps truth sweet if I did the gentle skin to skin etc to sooth her she would be asleep only to beg woken when she realised how hungry she was after I lay her down in her Moses basket. I think I would be up all night. So instead I cuddle her give her love and a supporting voice and if it does appear to be wind then I pat her bum whilst holding and try the gentle leg movements whilst she is lying on her back . On a positive she is gaining plenty of weight. Thanks for your thoughts. Has any one else experienced what I described?

My LO squirms Like that with wind! She wants to Feed so bad but is In pain with wind. I take her off, wind her then back on. And yes she falls asleep regular! Breastmilk contains the feel good factor.... Creating drowsiness xxxx

Hadnt thought of that about the feel good factor, thank u. So just to clarifie. In people's opinion it is normal for a 6 week old baby to fall asleep during breast feeding about 10-15 times during a feed and to make really loud noises and squirm to try and wake themselves up and still be really sleepy. Each feed taking about an hour and a half. ?

Some babies do fall asleep during a feed but I am not sure 10-15 times is with in the range of norm TBH.

What are her nappies like? You are looking for at least 6 heavy wet nappies (or 8 if you are using cloth) plus at least 2 poos the size of a £2 coin or bigger.

Are you still under the MWs or have you moved to HV team? Could you ask for an assessment with an Infant Feeding Co-ordinator or a Breastfeeding Counsellor (basically you want someone to watch the whole feed from latch on to end and really assess it [looking at positioning of baby/checking lips/cheeks/angle of body/swallowing/etc] not a 'that looks fine to me' assessment) as you may say she is falling asleep but it may just be pauses in feeding which is fine but it can be difficult to tell over the interweb!

Also, why do you think she is making noises to wake herself up? At 6 weeks she wouldn't have developed the thought processes to work out if I make a loud noise/squirm I will wake up (and if she did then she would be awake to be thinking it IYSWIM!). Babies do squirm a lot, and make funny noises - they have a very immature digestive tract and no sense of embarrassment hence the lot of noise

If there isn't a IFC/BFC available via the NHS you can phone one of the breastfeeding helplines (details on the MN bfing page) to speak to a local bfing counsellor (depending on which helpline you ring they might be with the NCT, Assoc. Bfing Mothers, Bfing Network or La Leche League) and get some info and reassurance.

Don't forget Angieweeks that night feeds when breastfeeding release a lot of a hormone to make both you and your LO sleepy (is it oxytocin??) and help you go back to sleep quickly afterwards.

But....my DS was just like this, feeding could take up to 90 minutes each time (day or night), he was putting on weight and pooing well but not feeding very well. He fell asleep after only a few sucks at the boob, I would wake him up, he would fall asleep etc etc. A 20 minute feed would take well over an hour.

So my HV finally referred me to a lactation nurse and she found that my DS had a posterior tongue tie. Had it snipped at 5 weeks and feeding has been a lot better and quicker since then.

I also had an entire breastfeed observed by a breastfeeding counsellor (someone from NCT) and she was brilliant, especially cos she stayed with me the whole time.

My DS makes loads of funny noises in his sleep, just strange baby noises. You learn to live with them/ignore them!

Also I am taking sertraline for PND and I haven't noticed any side effects on my LO. I take mine at night about 8.30 pm before the last feed of the night. I also agonised for days and days over whether to take the AD or not but my DH, HV and doctor were brilliant and basically I think it is better to have a mother taking AD than being stressed, anxious and depressed IYSWIM.

I took citalopram from about 4 months into my pregnancy through when DS was about 2 years old, and he was EBF till 6 months, and is still breastfeeding now at 2.6 years. I switched to sertraline now, but it was only because I didn't think the citalopram was working as well as I wanted, and sertraline was recommended as being a good one for breastfeeding and pregnancy (am pregnant again now).

No ill effects here, perfectly healthy and happy DS, and perfectly happy and healthy me!

A good person to talk to is Wendy at the breastfeeding network. She's a pharmacist who has compiled loads of information about drugs in breastmilk, so lovely and reassuring. I've contacted her a few times about various things.

Forgot to say I started taking my AD after he had his tongue tie snipped and then the feeding got better so his drowsiness when feeding wasn't down to the AD (cos I don't notice him being drowsy now and I look out for it cos of the AD)

Brilliant posts thank u x I think having someone watch a feed is a great idea but it is mainly worst at night time so I'm thinking of videoing it aswell as having someone come during the day