breastfeeding and anti-depressants

[redclover79]

hi
I was diagnosed with pnd a week ago and prescribed seroxat but my gp said as soon as i stop bf he wants to change what i am taking (he implied in the next month or so). I'm not happy about taking ad's while bf anyway and asked about alternatives- all i was told is that i shouldn't take st johns wort while bf...
are there any alternatives? ds2 is only 8 weeks and i don't plan to give up bf anytime soon, but i'm worried about taking ad's if gp wants to change drugs asap.
hope this makes sense to someone... tia!

Hello, by no means a medical expert here - I have recurrent depression and am currently taking ADs and breastfeeding, so I'll try to help!

I wouldn't be happy taking ADs for a month and then changing - they often take 2-3 weeks before you start feeling better anyway, so I can't see the point. You'd then probably have to come off the seroxat gradually before you could start taking something else. Did your GP tell you why he wanted to do it like this?

There are several ADs you can take while breastfeeding, and I'll find you some helpful links if you want.

In terms of natural alternatives - you shouldn't take St John's Wort while breastfeeding, but you also shouldn't take it at the same time as any 'conventional' antidepressant, so don't take it with the seroxat even if you stop breastfeeding. Other things you could try are a B vitamin complex, or fish oils. Reflexology is meant to be quite good - I've never tried it but a friend has offered to treat me so I will be soon.

Has your GP put you on a waiting list for any counselling or talking therapies? IME you get seen quicker with a baby - I waited 10 months for counselling once before, but I'm now seeing a community nurse once a week and having cognitive behavioural therapy.

If you don't want to give up breastfeeding, don't be pressured by the GP - there are plenty of ways forward. My GP wasn't sure what the best thing was for me to take, and referred me to a psychiatrist at the local hospital. It sounds a bit scary, but they have been very helpful and I think I'm finally getting some long term strategies to beat this - after nine years!

HTH a little, let me know if you want any of the stuff I've found on ADs and breastfeeding - and most of all I hope you feel better soon.

thanks olissa, my gp hardly inspires me with confidence (the first time I went to get help for pnd with ds1 I was told if I'd managed todrag myself out of the house and to the surgery I couldn't be that bad...)! although I've been diagnosed with pnd as far as I'm concerned I have 'normal' depression ie I was like this for a while before I had ds2 and have previously asked gp for a referral for cbt but he wouldn't offer me anything other than counselling which would have been fine but the counsellor went on long term sick leave 2 sessions in! Not that that's relevant to my current situation!!
It worries me that gp wants to change my medication asap because it makes me wonder what is wrong with the ones I've been prescribed?! I'm even less likely to want to take them while bf! Also, gp said there were only 2 ad's i could take while bf (can't take the other as I had side effects last time i took it).
Will look into reflexology not heard about using it to help with depression before!

Link for you about ADs and bf kellymom

It is totally safe (afaik) to take Sertraline while bf. I bf 3 kids on it, and was pg with two.

You can phone a bfc about this - a lot of them have the ref book "Medecine and Mother's Milk' which asseses the safety of medication during bf.

TBH it sounds lke your GP knows very little about bf. No GP shoudl be advising the mother of an 8wo to stop bf in a month if they do not need serious medication (like for psychosis or chemo or something)

I would ask for a psych referral for a psych with an interest in perinatal issues - I got one who was fab.

When I had PND, bf was the one thing I did that made me think I was a good mother when all else seemed to be crashing down round me.

Hope you can sort this out.

Amitriptiline is safe when pregnant and breast feeding.

I know because I saw a maternal psych when pregnant and she dealt with this stuff all day every day.

Also seroxat is recommended for bf as it has a short "shelf life", ie doesn't stay in system for long time
HTH

I am taking dothiepin and bfing with blessing of psychiatrist

The govt agency NICE reviewed this recently. They say, all ADs enter breast milk but those with the lowest levels and considered to be the safest are imipramine, nortriptyline and sertraline. Try to time feeds to avoid peak levels of AD in the milk (easier said than done if feeding on demand). There is no need to change AD when you stop BFing unless it's not working for you or you have side-effects. Alternatives to ADs are self-help strategies, counselling and psychotherapy.

By the way, I have just written a review of NICE's guidance on ADs in pregnancy and BFing! HTH

TheBlonde- thanks for the link will look at it asap!
Harrisey and fizzbuzz - psych referal sounds a good bet, it would be good to speak to someone with an actual knowledge (apart from mumsnetters obviously! ) rather than my gp reading up on it while I sit and wait! I'm feeling pleased with myself for bfing up til now and at the moment I'm feeling strong enough to recognise that I want to continue and not be coerced out of it to make the gp's job easier!
strawberry - any idea how long I should leave it between taking ad and feeding?! Am feeding on demand but there are certain periods that he goes longer than a couple of hours!
thanks everyone for your help btw, I'm still not 100% whether I want to take ad's but at least I have the opportunity to make an informed choice now!!

redclover......i was prescribed prozac five weeks ago when I was 36 weeks pg. I had my baby last week and the hospital weren't happy with the prozac as it shows up in breast milk so they changed it to seroxat as it is their drug of choice for BF mothers and they had me have a week free of ads before starting the seroxat.

I also had a referral to the mother and baby unit at the psychiatric hospital for the same day I started on the seroxat. they have told me not to take the seroxat as it also shows in BM, albeit to a lesser degree than prozac. They have put me on Lustral (or Sertraline) as this doesn't show up in breast milk at all. i must admit I feel much happier with this choice especially if it will help me to BF for longer.

Can you ask for a referral to the mental health team as they are more used to dealing with these issues than your GP?

whatever happens I hope that you can come to a solution that works for you with the BF. And good luck with the PND. It will get better soon

daisyboo, I was on lustral when I had depression and I had really dizzy spells all while I was taking it so I asked to be prescribed something else as I didn't think severe dizzyness and a small baby were a good combination... which is how i ended up with seroxat! Think I'm gonna go back to my gp and ask for a referal next week. Hope you are feeling better and congrats on the baby!!

Thanks Redclover, and I'll keep an eye out for annoying side effects.....so far so good, but I've only taken 3 doses so far!

Re: timing feeds, found this report from reputable website. It's a bit long but I thought some useful info:

Where possible, medication should be prescribed as a single dose and taken before the baby's longest sleep period. Ideally, the infant should be breastfed immediately before the dose is taken and breastfeeding should be avoided during peak levels (1-3 hours after the dose). For very young infants who are feeding frequently, one bottle-feed may be substituted to avoid peak levels of the drug. Infants should be monitored for drowsiness or other behavioural changes.

More recently, UK Medicines Information have answered the question ?What is the optimal management of depression in a breastfeeding mother?:

? With careful selection of the antidepressant and regimen and with infant monitoring, it is seldom necessary to deny the healthy, full term infant the known benefits of breastfeeding.
? The lowest effective dose should be used for the shortest possible time.
? Exposure of premature infants or those with compromised respiratory function to antidepressants via breast milk should be avoided.
? Elimination half-life of drugs may be prolonged in the neonatal period, increasing the risk of drug accumulation on prolonged exposure.
? For tricyclic antidepressants, imipramine or nortriptyline are preferred.
? For SSRI antidepressants, fluvoxamine, paroxetine or sertraline are preferred.
? Infants should be monitored for sedation, respiratory depression, weight gain and developmental milestones.
? Co-administration of sedating agents should be avoided."

thanks strawberry, I'm a little worried my gp didn't mention monitoring ds2 for sedation, respiratory depression, weight gain or developmental milestones... The potential effects of the ad's on ds2 are what worries me more than anything!