Antidepressants and Breastfeeding - Anyone who can help?

[sophia13]

I've started taking fluoxetine 20mg a day for anxiety / depression and am still breastfeeding. The doctor has advised me to stop bf but my little one, who is 10 weeks old, has so far refused the bottle. She just screams and screams, spits it out again and turns her head away. It breaks my heart to see her that upset! I'm also petrified as to what harm the ADs may do. I'm so scared and so upset - can't stop crying. I feel totally helpless and almost think the anxiety / depression is more manageable than stopping bf. But I know I'm not well, so will keep taking the tablets. Has anyone else experienced something similar? Is there anyone who knows anything about AD and breastfeeding and how bad for the baby it really is? Any advise on how to get her to take a bottle? I will speak to my HV and doctor again on Monday but advise from women who have had similar experiences would be so reassuring. Many thanks in advance.

my gp prescribed me ads i could take whilst bf.

if you want to bottle feed my 11 week dd takes tommee tippee ones with ebm in.

i would revisit gp

You are in luck because fluoxetine is the SSRI with the most data on it for pregnancy and breastfeeding.

The standard advice is that this anti depressant is suitable for breastfeeding. Your GP may just be unused to prescribing in breast feeding, so if you would like another opinion on this ask to be referred to your local community mental health team.

Also ask him if there are other treatment options for your depression and anxiety. I am thinking particularly of CBT or counselling.

Don't give up breastfeeding if you don't want to.Medication is not the only way to treat depression.

You do NOT need to stop BF!

Plenty of us have taken sertraline and successfully BF. I have! I'm taking sertraline right now and I'm 24 weeks pregnant.

There are even some who have taken fluoxetine and bf'd just fine.

Stopping BF cna make things even worse if it starts causing you anxiety.

hi sophia13. I'm under the care of the mother and baby unit of the local psychiatric hospital for my ongoing PND/AND issues. I was on fluoxetine towards the end of my last pregnancy. this was switched to sertraline as it is, according to my psych, one of the ADs that gets through least in breast milk, although I could have carried on with the fluoxetine if I had wanted. Evidence is that more fluoxetine gets through in BM than sertraline.

AS others have said, there is no need to give up BFing because of your depression and anxiety as there are compatible drugs out there. I would go and see your GP again, or see a different GP at your practice for a seciond opinion and ask at the same time for a referral to a health professional who deals with PND issues on a daily basis.

Meanwhile, there is advice on the effects of different drugs on kellymom and safefetus

Good Luck

Please don't feel bad, I think I posted the same thing when I started taking AD's. I take the same as you and my dd is now 15 months and still bf'ing.
I only started on the fluoxitine because my gp told me it was safe to use while bf'ing, otherwise I wouldn't have started taking them at all. Bf'ing was such a binding experience for me and my dd it would have made me more depressed to give it up.
Going onto the ad's was awful for the first 2 weeks, then things got better, and over time it's made my life livable. I've been on them for nearly 4 months and I'm getting CBT councelling.
It wouldv'e been impossible to put my dd on a bottle at 10 weeks, it took me months to introduce one.
Please come on here and post if your finding things hard.

and i forgot to add....like expat , I'm pregnant again (23 weeks) and back on fluoxetine, but will taper this off towards the end of my pregnancy to avoid any withdrawal symptoms in the baby and then go back on sertraline for breastfeeding.

"The selective serotonin reuptake inhibitors (SSRIs) paroxetine and sertraline can safely be given to a woman who is breastfeeding, provided the infant is healthy and his or her progress is monitored.
Citalopram and fluoxetine are less preferred, but could be considered if the woman has been successfully treated with one of these drugs during pregnancy."
from this sie which gives advice to GPs halfway down the right column

Could you ask the GP to ask the local hospital pharmacist for specialist advice on this one ; a lot of doctors think that there is a blanket ban on ads during breastfeeding but this is not the case.

Your GP should find out more and maybe consider swapping you onto a different AD; they are all much the same in terms of antidepressant effect.

Breast feeding is the very best start for your baby; even with you on ads it is better than ff, and trying to get a bf baby to bottle feed can be impossible and upsetting - Ive been there!

I think that you are doing brilliantly and that you are being a great mum to be so concerned for your little one. Depression is horrible and you feel awful about anything you can find to feel awful about. The ads should help with this.

I am on a high dose (60mg) of citalopram and am breastfeeding with the support of my GP, consultant and HV. I also have a degree in pharmacology so went deeply into this sort of problem when I was pregnant. DD is 6 months old and a very happy healthy baby, and I am a happy healthy mum on my medication.

TikTok is a bit of an authority on this sort of thing, will try to keep this bumped for her to see

Thanks for all your advice and encouragement! I feel less anxious after reading your replies - hope I can get some sleep tonight I will definitely ask my GP to find out more before I stop breastfeeding. From what you're saying I really hope that I can carry on. Bf'ing is such a lovely thing, to look down at her little face happily feeding is just wonderful. That said, I would like to get her to accept a bottle, just in case... and also so that I can have a little break now and again.

The Breastfeeding network have a specialist drug and breastfeeding information line, and some downloadable/printable leaflets here that is very detailed and is worth taking to your doctor

I am so scared now after reading more about drugs in breastmilk. The thing is I was taking Fluoxetine during pregnancy, at a reduced dose of 10mg a day then for the last 2 months, tapered it off to less than 5mg. After the birth I stopped completely as the low dose I had been on possibly wasn't having a theraputic effect anyway. According to the BF network information the use of Fluoxeting in pregancy then subsequently during breastfeeding can cause sedation and even coma in the baby. I will be straight down the doctors' tomorrow morning. Have not had any luck with bottle feeding still. I'm so worried. I can't see a way through this. Just feel I can't cope...Sorry to post such a negative message

you DO NOT have to stop bfing at all if you don't want to, sophia.

keep it up if it's making you and her happy.

you can switch from fluoxetine to sertraline at that low a dose without stopping one or stopping BF.

see someone who's a little more clued up about BF and ADs.

LOTS of us have been there and successfully BF whilst on ADs.

I took prozac at the end of PG and whilst Bfing (20mg). This was at beginning of 2004, so of course research moves on, but consultant obs/gynae, psychiatrist, and psychiatrist's pharmacist were all perfectly happy for me to take prozac whilst bfing. The research was explained to me as showing that there were tiny traces of Prozac in the breast milk, but hey didn't have an effect on the baby.

Sofia, please dont worry too much, and please keep feeding your baby. I hope your trip to the doctors is useful and thaqt you will l=et us know how you got on.

I'm now waiting for my GP to call me. I've spoken to my HV who was surprised that my GP had told be to stop BF'ing as their usual advice is NOT to stop. She advised me to talk to my GP about which drug to use to minimise any risks to the baby. Just like you've all said, she said not to worry too much and that although it's not ideal many mums BF on AD's and the babies are just fine. This had definitley lifted my spirits I just hope the doc calls soon and that he will be as supportive once he understands how important it is to me. Will keep you posted.

Hi, I hope that the doc has got back to you by now. I am glad that you have a sensible and supportive HV.
I hope that you are feeling less worried now

Thank you Thingamajig. My GP phoned this afternoon after having consulted with the other GP's at the surgery to say it was fine to continue bf'ing and taking Fluoxetine. He even apologised for confusing me last week. I couldn't have wished for a better outcome! Of course, I'm still worried - but as the AD's start working again I will hopefully feel better. My dd has sleps so much today and I just can't help worrying if the drug is making her sleepy. My HV is visiting on Friday, too, so that's good.

i've just been given fluoxitine by my gp as i was treated with this before i was pregnant, i was told to stop beast feeding this weekend and start taking them monday, my daughter is 6 months old monday and has been refusing the bottle for the last 3 months so what hope do i have of stopping over the weekend.
i know that i dont want to stop bfing as the very thought of being told i have to made me cry, i would love to mix feed to aloow me to rest which is why i've been trying so long to introduce a bottle.
she comforts on me so if i take that comfort away from her how is that supposed to help me recover the thought of having to watch her become stressed and upset and knowing what she wants, just the thought of that is upsetting enough!

Puddled - as you can see here, its safe to take fluxotine and breastfeed so theres no need to give up. If you'd like to mix feed (although as she starts solids she'll start dropping feeds which will let you get more rest) then have you tried a cup and straw rather than a bottle ? Many babies find that an easier choice than a bottle.

Hope you start finding things easier soon

hi puddled

this thread is a good few weeks old, so I'd suggest starting a new one in this topic to get some advice just for you as sometimes people just read the OP and respond to that so might miss your post.

The good news is that you DO NOT have to give up BFing in order to take antidepressants. There is advice on drugs and BFing on the La Leche League website and the Association of BFing mothers website as well as on The Breastfeeding Network site and on kellymom.

I'm pregnant and taking fluoxetine but will swap to Sertraline on the advice on my psychiatrist who runs the perinatal MH team in Leeds. Sertraline has been shown to get through the least in BM of all the SSRIs and the theory is that BM with a trace of AD in is better for the baby than no BM at all

I'm sorry you are feeling poo, and hope that you can get things sorted out soon.

hi i am a newbie here. i have been taking fluoxetine for 8 years since my daughter was born (previous to this was on and off ads for several years). i had my son in 2005 and took fluoxetine throughout my pregnancy, but was advised not to bf,which upset me a lot. my bot is absolutely fine and didn't suffer any effects. I am now pregnant again and am so desperate to be able to bf. i am unable to change my ads as have tried them all over the years and fluoxetine is the only one suitable for me. i take 20mg a day. no one seems to be able to give me a straight answer about if it will be safe or not to bf, please help, obviously i want whats best for my baby.

sophia, I'm glad you managed to get some good advice in the end.

The adverse effects that you read about for antidepressents in breastfeeding are actually very rare. The drug companies are obliged to report ant potential side effects that people think they have experienced, whether it is remotly plausable, or even if it is just one baby.

When you look at the information in detail typically it is very very small numbers reporting any problems, but the companies have to mention it anyway.

Breast milk with a little bit of SSRI in it is better for the baby than formula.

The risks (if there are any!) are actually lower for your baby then for most, IMO, as your baby has already been exposed to floxetine when you were pregnant, so this is just more of something they have already had, rather than something entirely new.

mimi, fluoxetine is usually fine. Obviously you arent going to want to take definitive advice about this from an internet forum, but speak to your GP, and if they arent sure then ask them to talk to thier practice pharmacist, or to refer you to a psychiatrist, who will be able to advise you.

There is some good information here:

link

Have a read of the information about fluoxetine, maybe print it out and take it to your GP so they can see it. GPs have an awful lot of things that they have to keep up to date with, so not surprising if occassionally they dont know current thinking in particular areas.

mimi...ask your GP for a referral to the perinatal mental health team if there is one locally, or for a referral to a psych who is knowledgable about BFing and medication.

I was advised (by my psych who runs the perinatal mental health unit in Leeds) that sertraline is better for BFing than fluoxetine, but that fluoxetine has been used successfully in BFing. tigger's link would support that view.

Great link tigger

I was also worried and had a long chat with my doctor who showed me the guidance book (not sure what it's called, sorry!). It said 'guidance recommended' which he basically says they don't NOT recommend it, if you see what I mean, but that it was up to me. After doing loads of surfing and research I decided to mix feed as the idea of giving up BF was making me feel more depressed, not exactly the idea .

I did this for three months til I decided to stop BF as I was going back to work and DD was 6 months and ready to wean. I could not detect any sign at all that she was affected in any way. The mixed feeding was a good idea in the long run as it helped when I went back to work too.

reading your letters as helped me as i am a mum and are trying for a baby also on sertraline75mg so i was quite worried but also feel sertraline will be safe as any