Antidepressants
“My doctor wants me to take antidepressants and suggests that I wean my baby, but I don’t want to give up on breastfeeding. Can I take antidepressants and still breastfeed?”
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.