pospartum depression--Prozac--and breastfeeding
Q.Question for all of you moms who had or have postpartum depression--I had a beatiful baby boy four weeks ago and I'm having a hard time dealing with lack of sleep, caring for the baby, and dealing with my parents who are visiting to help take care of the baby, and my husband who has some issues with my parents. In addition, it's wintertime and I'm always more "down" during winter. A psychiatrist said to try first light therapy boxes, which I started on Sunday and I think it helps but I'm going to see her again on Monday and we are supposed to decide if I should go on medication. If things don't get better maybe I should, but I'm worried about the effect of medication on my baby (I'm breastfeeding). So questions to all of you moms out there who are and were on Prozac or other medication--how does/did that affect your baby? Did you notice any behavioral changes? What other ways of dealing with PPD are there except medicaton?
A.Women with postpartum depression can safety use sertraline while breastfeeding without appreciably affecting peripheral serotonin transport in their infants, Yale University researchers report in the American Journal of Psychiatry for October. According to a second paper in that issue, the use of venlafaxine during pregnancy does not increase the risk of birth defects. Dr. Neill Epperson and associates in New Haven, Connecticut measured platelet levels of serotonin in women and their infants before and 6 to 16 weeks after sertraline treatment was initiated. At the time the sampling was conducted during drug treatment, the dosage ranged from 25 to 200 mg daily. For 13 mothers, the mean maternal serotonin level before taking sertraline was 158.7 ng/mL, which declined to 18.7 ng/mL during drug treatment. For the 11 assessable infants, the sertraline concentrations did not differ significantly before and after exposure to sertraline, 227.0 ng/mL and 223.7 ng/mL, respectively. Dr. Epperson's group notes that none of the infants exhibited any adverse effects or changes in behavior that could be related to sertraline exposure. Similarly, Dr. Epperson told Reuters Health that she has not seen "any unexplained types of events" in infants in her clinical practice. "With respect to Zoloft, I would say that a mother could breastfeed without exposing her infant to a physiologically meaningful level of the drug," Dr. Epperson told Reuters Health. Although she couldn't say for certain, Dr. Epperson noted that similar results would likely be found for selective serotonin reuptake inhibitors with similar half-lives, such as Paxil and Luvox. "If you look at breastfeeding studies, they found similarities between Paxil and Zoloft with respect to infants having low blood levels, but breast milk levels are not exactly the same," she said. "I tell my patients that if they see an unexplained change in their infant's behavior, such as irritability or a dramatic change in sleep pattern not attributable to [an illness], to tell their pediatrician. Anybody can have an unexpected adverse reaction, although in this case it would be unusual." Separately, Adrienne Einarson, of The Hospital for Sick Children in Toronto, Canada, and colleagues from seven centers prospectively ascertained the outcomes of 150 pregnancies after exposure to venlafaxine. Doses of 37.5 to 300 mg/day were used during the first trimester, and 34 women used the drug throughout pregnancy. These data were compared with those from a study of 150 pregnant women who used SSRIs and another study of 150 women who used drugs during pregnancy that were known to be nonteratogenic. The rates of major malformations and stillbirths, as well as gestational age at birth and birthweight, did not differ among the three groups, the investigators report. There were two major malformations in the venlafaxine group, three in the SSRI group, and one in the nonteratogenic drug group. There was a nonsignificant trend toward higher rates of spontaneous abortion in the venlafaxine and the SSRI groups, 12% and 11% respectively, compared with the nonteratogenic drug group, in which the rate was 7%. Einarson's group suggests that there may be an association between depression and higher rates of spontaneous abortion. "Women who have been diagnosed with depression before becoming pregnant and are being successfully treated with medication should not feel that they automatically have to stop their medications as soon as their pregnancy is confirmed," the investigators maintain. Am J Psychiatry 2001;158:1631-1637,1728-1730. You could always just forget the drugs and wait it out. It does go away after a while. That's what I did. I was pretty depressed for maybe three months--I forget exactly how long. I also gave birth in the winter--January. It wasn't fun, but I didn't have to add the worry about whether some medications were harming my baby in some way (now or in the future), and I think I learned a lot. This may sound scary, but as your baby gets older you may realize how EASY it was to take care of a newborn. : ) And you will never sleep as well as you did before you had a baby... Take every chance you get to take care of yourself--SLEEP, take a long bath, read a book, go to the mall--whatever. And GET OUT of the house! This was one of my mistakes--I spent the first two weeks confined to the apartment (had my baby at home and neither of us went through the door till she was 11 days old). My mom came to help for a while, and my husband took a few days off from work, and that was nice, but I needed more. I needed to get out and see other people and pretend that I was a "normal" person. One thing I did that helped me sleep better was to bring the baby to bed with me. It's soooo much easier to just lie in bed and feed your baby whenever he needs it, rather than getting up, going to his crib, sitting in a chair while he eats, etc. So much easier in fact, that my daughter still sleeps with us a lot (she's 23 months). So this may be a good temporary solution to your sleepness nights, but if you don't want the baby to get into the habit of sleeping with you for a couple years (which is good birth control, btw), be strong and break him of it when you're not so depressed anymore. The parents... My husband also doesn't get along with my parents, so I understand... How long have they stayed? Maybe it's time for them to leave. Is the stress of them not getting along causing you more stress and depression? If so, tell them you've appreciated their help, but would like to try it on your own now. One note about Prozac: I know two people who used it (not for PDD though). One feels that it's a lifesaver for her. The other felt like killing herself while she was on it... I don't know anything about it's "safety" while breastfeeding. I prefer to stay away from all medications whenever possible in the least, breastfeeding or not. I have been taking anti depressant medication since my son was 5 months old. I am still breastfeeding. I have not noticed any changes in my son since starting first Zoloft and now Efexor. If there are any alternatives I would love to hear about them.
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