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7 Essential Facts About Breastfeeding and Antidepressants

Jennifer Lincoln, MD, IBCLC, Board Certified OB/GYN
January 3, 2019 . 17 min read

With preexisting mental health issues and postpartum depression/anxiety affecting up to 20 percent of all new moms, many women worry that taking antidepressant medication while breastfeeding can harm their infant. Here are some facts to set the record straight.

It’s sometimes possible to treat postpartum depression/anxiety without medication… When symptoms are more mild, therapy is actually considered the best treatment and should be tried before an antidepressant is prescribed. Other modifications should be tried too, such as working on good sleep habits (including having someone bring your baby to you for feeds but then leaving you alone to get a good night’s sleep), increasing exercise, and making sure you have enough help at home.

…but not always, and there are safe antidepressants for breastfeeding moms. There is no one antidepressant that is considered the best, but often medications called SSRIs are used because they have been studied the most in breastfeeding women. Your doctor can figure out which one is best for you based on your symptoms and history.

If you are breastfeeding and need an antidepressant, a few factors are considered to make this a safe choice for your baby. All medications enter breastmilk, but how much your baby is exposed to is based on many factors: the size of the drug molecule, the dose, the time you take it, and more. This means your doctor can prescribe one that has the lowest amount transferred to your baby and work on the dosing and timing of when you take it. The SSRIs sertraline (Zoloft) and paroxetine (Paxil) are often used in breastfeeding moms for just these reasons.

We know it’s worse for babies to have a mother with untreated depression than one who is better because she takes an antidepressant. Studies have shown babies of untreated depressed moms fare worse on many accounts: they have worse brain development, poorer mother/infant bonding, are breastfed for shorter lengths of time, and have issues with attachment and developmental delay. It is definitely better to take a safe medication than to avoid it and have ongoing issues with depression.

It’s normal to worry about how a medication may affect your baby, but side effects are rare. Some side effects have been reported in babies’ whose mothers took antidepressants. These include infant jitteriness, irritability, and poor sleep. However, these problems were very rare and in some cases may have actually occurred from withdrawal after Mom stopped taking the medication. Again, the issues with untreated depression (see #4!) are far more common than these side effects.

Stopping a medication without telling your doctor is never recommended! For the reasons mentioned above, as well as the problems this may cause in a woman who abruptly stops her antidepressants (this can lead to suicidal thoughts, manic episodes, as well as feeling physically ill), you should never go off a medication without checking with your doctor first.

Stopping breastfeeding because you are worried about your antidepressant isn’t recommended either. It’s completely normal to only want what is absolutely best for your baby, and many women feel (or are told by friends and family) that weaning is the safest thing for their baby, rather than having him exposed to a medication. While this is always a personal decision, keep in mind that removing the benefits of breastmilk from your baby likely has much higher side effects than a minimal exposure to a safe medication. Also, some women think issues with breastfeeding is causing their depression and weaning is the best route. Before you take this leap, please check in with your doctor and lactation consultant! You may be able to troubleshoot, and many women with postpartum depression have said breastfeeding was a great way to continue to bond with their babies while they dealt with their depression.

Sources:

  • The Academy of Breastfeeding Medicine
  • Clinical protocol #18: Use of antidepressants in breastfeeding mothers.
    Riordan and K
  • Wambach
  • Breastfeeding and Human Lactation, 4th edition.

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