Yes, but antidepressants should be used with caution. Antidepressant medications currently in use include the serotonin reuptake inhibitors (SRI's), lithium, tricyclic antidepressants, and St. John's wort. You might also consider alternatives to medication for depression alternatives to medication for depression. However, there are good reasons not to wean even if your depression must be treated with medication.

The most commonly used antidepressants belong to a group of medicines collectively known as SRIs (serotonin reuptake inhibitors), such as Prozac (fluoxetine), Paxil (paroxetine), and Zoloft (sertraline). All these medications act similarly by boosting brain levels of the natural mood-elevating neurochemical, serotonin; they differ mainly in the strength of their action and in possible side effects. Some people do better on one of these drugs than on another. Zoloft seems to be the safest to take while breastfeeding. In studies of many breastfeeding infants whose mothers were taking Zoloft, the drug has either been undetectable in the infant's blood or is present in insignificant amounts. Paxil would be the next choice, and Prozac the last choice, even though it too is considered compatible with breastfeeding. One case of severe colic has been reported in a breastfeeding infant whose mother took Prozac.

If you and your doctor feel that you definitely should take an SRI medication, start with Zoloft in the lowest dose that achieves the desired effect. If this is not effective, in consultation with your doctor, try Paxil. If your doctor wishes you to take Prozac, start with a low dose and gradually increase it.

If you require higher doses of these drugs and you are worried about the effect on your infant, ask your doctor to measure the blood level of the SRI in your infant on two different occasions, preferably 2-6 hours after you've taken the medication. Bear in mind that part of this test will have to be done in a special lab and may be expensive. We would recommend going to this extreme only if you are taking relatively high doses of Prozac. A low blood level in your infant would reassure you that you could safely take Prozac while breastfeeding.

Be sure not to take SRIs, or any other antidepressant, in conjunction with any other medication without first checking with your doctor and/or pharmacist. SRIs should not be taken with the following medications: lithium, cimetidine (anti-reflux drug), theophylline-containing medications, anti-convulsants, and other antidepressants.

Lithium is used to treat manic depression and is in the use with caution category while breastfeeding. If all alternatives have been explored and both you and your doctor believe that this drug is necessary and premature weaning is undesirable, lithium could be taken while breastfeeding, provided baby's blood lithium level is closely monitored, approximately every 2-4 weeks. Like all drugs, the more frequently you breastfeed and the younger the infant, the greater the concern.

Most antidepressants in the tricyclic category are listed as "safe to take while breastfeeding," except DoxetIn . Elavil (amitriptyline) is safe to take while breastfeeding. While an occasional dose of Valium (diazepam) is considered safe while breastfeeding, prolonged use is not advisable.

While St. John's wort (hypericum perforatum) has been scientifically shown to be an effective antidepressant, its safety for a lactating mother has not been proven. Some authorities believe it could decrease a mother's milk supply. If you are considering the use of St. John's wort as an antidepressant, it would be wise to consult a doctor familiar with the latest research on the safety of this drug while breastfeeding. As with many herbs, St. John's wort requires an individualized dosage, with careful observation of the effects. Some mothers can safely take this herb without any change in their milk supply or effect on their infant, others cannot.

Before taking antidepressants, consider alternatives. Some mothers who required antidepressants prior to having a baby have found that the relaxing effects of breastfeeding have enabled them to lower the dosage or get off these medications entirely. Mild depression often responds to simple changes in your lifestyle: exercise, attitude modification, and nutrition. (See "postpartum depression" for more suggestions.)

Physicians sometimes recommend weaning while taking antidepressants or other psychiatric medications because it seems to them the safest and simplest alternative. You may have to be the one who seeks out additional information or who presses your physician to learn more about medications and breastfeeding. Impress upon the prescribing physician that you wish to continue breastfeeding and that this is an important part of how you care for and mother your baby. Abrupt weaning in itself can cause depression, so the effects of weaning on your feelings should not be taken lightly. Give your physician the clear message that you want safe alternatives. If your depression is making it difficult for you to be an effective advocate for yourself and your baby, enlist the help of your husband or an articulate friend in talking with the doctor.