Looking for advice on the BF v antidepressants guilt maze

[entropygirl]

Hi,

I was wondering if anyone had experiences or advice on navigating the guilt maze of having pnd, wanting to continue BF but not wanting to put antidepressants into the baby?

I feel bad because I know pnd will affect my DD's development.
But I dont want to give up BF as it is the only time I get to be happy and physically close with my DD.
I am not (currently) prepared to take the pills as although they are rated safe for BF, what the research actually says is that the drug does go into breastmilk and can be detected in the childs system and that while adverse affects are rare there is some discussion about abnormal spinal development and more research is needed on long term effects.

Have previously been keeping things fairly under control with CBT etc. but having gone back to work a month ago and encountering stresses there I am now 3 days without meaningful sleep and crying all the time. Hence I am reassessing the situation....

DD is 5 mo, and due to unemployment, labour complications and pnd, DH has been DD's main carer for most of her life so far.

Any and all advice/comments will be gratefully received!

I could say no guilt required but it ain't that easy is it. I mean it though. BF is precious, but not as precious as you and your dd being able to enjoy each other and be close. Whichever one you choose to do, bottle or bf, meds or not, your dd will be fine.

I think I would chose to take the ADs and BF, but that is a personal choice, and influenced by the fact that ds had antivirals, antibiotics, 6 different anti-epileptic drugs and morphine pumped into him within hours of his birth and has survived just fine. And he greatly benefited from a year of bf. It also helped me bond with him after a really bad start, I was not depressed but other pretty horrible things got in the way.

I don't know if this helps - but don't panic if you feel you feel she is closer to your dh. It is important that she bonds to one of her care givers but it doesn't have to be you. Once a child bonds securely with a caregiver she can do it with others too.

Get yourself better - that is your main priority - for all of you.

Thanks for replying madmouse.

I agree that BM isnt all that important - particularly by 5 mo. But if I stop I am worried I will lose the only time I have to hold her and be happy. I didnt mention in the OP but she is a very standoffish baby. Hates being hugged or cuddled and always squirm to face outward/get off knee entirely. She only looks at me if Im looking away, as soon as I look at her she breaks eye contact. I'm trying not to blame any of that on the pnd because she has been like that since 2 days old, but it is difficult.

So, if I quite BF then I wont ever get to hold her while she is contented. Am worried that loss wont be offset by the AD.....but then I havent tried AD, maybe they are a miracle cure....

ADs can work very well and make an enormous difference in how you are feeling. My dh is on a low dose and it has worked so well and really helped him to get out of the hole he was in.

I can understand why you don't want to give up BF - those feeding and cuddling moments are so special, even more so if you feel it's all you get.

Some babies are a bit prickly and irritable regardless of what you do and are not keen on being held a lot. How is she with playing together? Reading stories on your lap?

Would you give ADs a try for a few weeks while still bf to see if the benefits are worth it?

I am not a doctor but i work in mental health and know that if the ad's work for you and are seemingly beneficial, stick to them... dont alter doses without asking your gp. Also you are alot more help to your baby at home than in hospital, have you emotianal support from family friends etc...? as drugs are just a complimentary factor.

Sorry man my op was not at all clear....

I am not taking the pills I was given after my little trip to hospital because I hoped that knowing the nature of the beast would give me the handle i needed to get myself sorted. This has mostly worked out okay but I am now back at work full time and the added stresses of work seem to be firing the cycle back up even though I can now recognise the signs.

So it is a question of whether or not to start taking the pills.

The fact that I am not DD's main carer is balancing out the fact that I would otherwise be quite certain that any damage done through exposing DD to pills would be offset by having a happier mum.

Gah it is starting to look like stopping the BF is the way forward. Will talk to DH.

Which ADs are they? Some have a lot of history suggesting safety, others not so much.

No need to then feel to guilty .

I am on Sertraline and breastfeeding my 15 month old. We are both getting on very well with the medication. it has made me much happier and more positive and motivated. I haven't had any side effects and I.still feel like me.

I made a choice to take ADs and bf as I felt the benefits outweighed the risks.

Can you get more time off work to concentrate on getting better and bonding with your baby? I get full sick pay now.

I've taken ADs throughout 2 pregnancies (2nd just coming to an end) and I have breastfed on them. It's a very tough decision and I feel for you for having to make it. I decided that the benefits of breastfeeding would outweigh any detrimental effect of the medication. Who knows if I was right?

I'm currently debating whether to breastfeed my newborn when she arrives. Coming off the ADs isn't an option for me as I wouldn't be able to look after my other children properly without them at the moment.

My son did experience a week of withdrawls when I stopped bf. It wasn't nice at all - he was very jittery and wouldn't be put down. But I'm sure he won't remember, and it did only last a week. He didn't need medical attention or anything.

I think in your situation I'd be inclined to stop bf and take the tablets. The fact that your baby has had 5 months of being breastfed is fantastic. Try not to beat yourself up, whatever you choose.

Thank you for sharing your stories with me - it never ceases to amaze how open and sympathetic people on MN can be.

I just keep putting off making the decision (which is a decision in itself) hoping that things will magically be better. Now I am starting to panic that I am missing my baby. Gah! I dont suppose that a complete inability to make a rational decision is one of the side effects of depression? Talk about over thinking things!

Right I am going to talk to DH, although another whole set of contradictory feelings is unlikely to help, he has a say in this too.

Thank you all again!

I took Sertraline and BF. Do it, you wil feel so much better!

Yes it is setraline I have been prescribed - it certainly seems as safe as it gets.

Sertaline is fine for BF. I took it while Bf ds and he suffered no ill affects. I was told that the body is very good at stopping anything vaguely poisonous getting into to breastmilk. I chose to continue breastfeeding and take anti depressants because I felt that that bf with a microscopic trace of medication was less of a risk than the risks with formula. It is an individual decision and a balance of risk.

Also your child will soon be ready for solids and the proportion of his diet that is breastmilk will decrease. Once your dd is eating three meals a day she will not want so much breastmilk.

CBT is great, but if your depression is really bad then it hopeless. You need temporary lift that medication will give you.

www.breastfeedingnetwork.org.uk/pdfs/Antidepressants_and_Breastfeeding_March_2009.pdf

"Sertraline is the AD of choice for the breastfeeding mother"

I found breastfeeding really helped me from 6 months onwards, when it got slowly easier.

I have been on ADs for both my pregnancies and am still BF on them (citalopram and lithium), and I wouldn't have done things differently. I do not even feel remotely guilty for doing so. Feeling guilty is a big part of depression (as is an inability to make decisions!), but a happy healthy mummy will mean so much more to you baby than a trace of ADs in your milk. As others have said, she is a big baby, not a tiny newborn, and soon she will be taking solids alongside the BM, so any effect on her (and I am convinced there is no effect on my twins or DD1 ) will be lessened.
I can see that it is really important to you to have the happy, cuddly time with her that BF gives you, and that it would make you sad to lose that. It is also really gratifying to be needed, especially as I get the impression that you think she prefers your DH to you (again this is the sort of thing that depression distorts).
In your position I would continue to BF and take the ADs
Good luck with it and take care

Thanks all for the info. I think I am convinced...I just need to convince DH....he has a bit of a thing about drugs (I am only allowed to even sniff alcohol if its at least 3 hours till the next feed....)

For info, my AD was fluoxitine, which isn't great for b/feeding, but I felt too anxious to change it. Sertraline has a different half-life or summat, so is less present in milk.

Just tell your DH what is happening. Your health, your body, your choice.

And there is no harm in having a glass of wine or 2 when you are feeding, none at all.
I don't like the sound of him telling you what to do like that, it isn't right.

hmmmm Alibabaandthe80nappies I am bit gutted reading your message just after being told by DH that there is no way I can take the pills....

I think its my say what I put into me but my DH does get a say on what goes into DD.

So that brings me back to take pills or breast feed.....and another week has gone by. Am starting to get shaky again so I think it may have to be pills. Why oh why I am such a shit mum?

Why is your DH so against? Does he want you to be miserable?

There is no danger to your baby with you taking Sertraline. Your DD's life will be far more adversely affected by having a mother with depression.

Take your DH along with you to your GP, and get his buy in on the pills.

I cannot believe his attitude, how appalling. :(

You are not a shit Mum, you have PND. It is a chemical imbalance, not caused by you or anything you have done. But very possibly made worse by having a controlling husband...

Take the pills, and carry on BFing. That is a best outcome for both you and your DD.

What Alibaba said - it looks like your DH doesn't understand what is going on. I agree that you have a joint say in what goes into your DD but within reason.

I think its mostly that he thinks CBT is the answer not pills. I think in the long run he is right but that doesnt help me right here and right now.

CBT maybe the answer when medication has lifted your depression to the extent that you CAN do the the work involved. It is completely hopeless to treat moderate/ severe depression without medication. You probably need both.

Formula feeding carries risk and so does breastfeeding with anti depressants. Sertaline is very safe and there are less risks than switching to formua feeding.

PND harms a child development if it is left unchecked. You need to take the meds before your illness gets worse.

Hi Entropy, I had exactly the same conundrum with my dd when i was diagnosed with PND. I ended up trying acupuncture for a few months - it didn't work and the PND just got worse. In the end I tried the sertraline (starting on a low dose and would have stopped as soon as saw probs in dd) and never looked back! When ds came along 7 months ago and i started to get pnd again i just went straight on them. Sertraline doesnt seem to be working for me this time but it did work last time.

Please please please don't stop bf; I don't normally "bully" people into bf but I truly believe that will only make u feel worse. My dd was also not an affectionate baby , didnt like hugs and the bf time was so precious to me. If its any consolation she's now 3, her spine/ posture is unbelievably good and she loves hugs :o)

You are a BRILLIANT mum for Breastfeeding at 5 months even tho u are back at work - I have read that only 3% of mums get to 6 months with bf. you thinking u are a bad mum is just the PND.

I totally get where your DH is coming from, and I don't think it's fair for other posters to give u a hard time over that tbh; but I do agree with the other posters in that the benefits of having a mum without PND far far outweigh the risk associated with sertraline. So many women who bf are prescribed it.

The decision you need to take now is similar to the decision to have the flu jab when pg, the MMR and countless other decisions u need to worry over as a parent - you worry yourself silly beforehand then make your decision and wonder in a month why you were so worried about it - at least u do anyway.

Big unmumsnetty hugs to you xxxx

Is dd a good sleeper? I took mine last thing at night after her final feed to minimise the possible transfer.

That should say "at least I do"! Sorry for mammoth post!!