Depression while Breastfeeding

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Exhaustion, nursing and depression

Sept 2012

Hi BPN,
My daughter was born 5 days ago by a c-section and I seem to be caught in a downward spiral. I am trying to nurse her exclusively and am finding she needs to be nursed every 2 hours or so. She doesn't seem to like being swaddled and wiggles at least one arm free if not both, but it seems the only way she will continue to sleep after nursing without someone holding her is to be swaddled - that's what they did at the hospital. My husband and I are trying to learn how to become better swaddlers. If you have any tips/advice/gear that is great.

This inability to put her down is wreaking havoc for me - I am now at 7 days and counting (labor started 7 days ago) on 2 hours of sleep a night. I ended up with a c-section and the sleep interruptions continued the 4 nights in the hospital. At this point I am exhausted, weepy with pp blues and unable to sleep for more than 1 hour at a time even when I get a chance. My eyes automatically pop open. The exhaustion is causing depression and the depression I suspect is not allowing me to stay asleep and is causing further exhaustion. I am so exhausted I am literally crying. How do I break out of this cycle? I want to enjoy my newborn and do the right thing for her. I ended up supplementing with formula for my first born for a number of reasons and wanted to do it right this time. How do other c-section moms cope between the pain and sleep deprivation? How do I break out of this cycle? I am getting so upset/worried about not being able to sleep I think that's becoming a cause itself... Sleepless new mama

Hello Mom! I have gone through what you are going through, and I understand the vicious cycle that no sleep/hard to eat/nursing can become. Here are my suggestions: 1) What is best for your child is for YOU to be healthy and happy! It is more important than exclusively eating breast milk. So, let's start by getting rid of the guilt over giving formula. How can you cuddle and bond when you are sleep deprived and depressed? 2) One of my friends swore by a swaddling product that had velcro to keep it in place. Can't remember the name, but i'm sure you can find it a babies R us. 3) You need to have at least a 4-5 hour stretch of time where you aren't responsible for the babe and can sleep. This is what is going to break they cycle. Have your partner keep watch with some formula or pumped breast milk (if you can manage) or combo. If your babe is waking every 2 hours to eat--this is only ONE feeding. No biggie! 4) Part of my pp depression was my inability to eat. My hubby gently forced me to eat, and I discovered that sugar was my savior. If I drank a milkshake, I felt so much better. Try a Jamba Juice or whatever sugary drink you like that would still be OK for baby. Turns out, sugar is a natural anti-depressant! Worked wonders for me. been there, done that!

I feel for you. I went through the same thing and I think that the change in hormones so abruptly can actually cause anxiety and insomia and once it starts we start to spiral. Had I known anyone at the time, I would have hired a person to come in a few hours a day and from 8pm-2am each night so I got guaranteed help. I would talk to your ob, hire some help and take good care of you. The newborn phase goes fasts when we look back on it, but while in it seems so long and draining. Don't feel bad about supplementing either. Heather

I'm so sorry to hear about such a hard time you're having, and I can sympathize. I have two daughters--with my first, breast feeding was a struggle and she woke up every 45 minutes to eat. I wanted to breast feed exclusively and did breast feed exclusively until she was 6 months old, but it was a nightmare. I ended up so exhausted that I hallucinated a few times and I became severely depressed and contemplated suicide. Looking back, I realize that the first few months of my daughter's life were the worst of my life. Not a great way to start off motherhood. My second daughter couldn't breast feed because of a mouth issue, so I pumped and my husband and I fed her with a bottle; we also supplemented with formula. I know that ''breast milk is best,'' but supplementing with formula made all the difference with my second daughter. I suspect now that I wasn't producing enough milk with my first and she was probably constantly hungry, which caused her to wake up all the time. So, I strongly encourage you to supplement with formula, take a few nights off and let your husband take care of the baby--go to a hotel if you have to so you can get some rest. You HAVE to get sleep. Also, please see your doctor ASAP and let her/him know that your having difficulties. They can also help you feel better. Hang in there... things will get better. anon

First off, by asking for advice/help, you are DOING IT RIGHT! Second, it WILL GET BETTER. Now, for your questions. Buy a ''cheating'' swaddle blanket or two - the kind with velcro straps - for sale at Target, etc. These saved us, we could never swaddle our son with blankets and the velcro kept him wrapped up all nice and tight.

Can you afford a postpartum doula, even for 1-2 nights? You might consider the overnight help, but it is EXPENSIVE. Such a person would sleep on your couch, bring the baby to you for nursing, but she would do everything else - swaddle, diapers, etc. And would likely help you out by making breakfast, tidying before she left, etc. Something to consider if you can swing it financially. If not, this is the time to ask for such help from friends or family. There are few times in our lives when we really need to ask for help, and this is one of them! Is there anyone you can have just help for 1 night or 2, so you can get ''centered'' again?

Finally, it will get better! Also, talk with your doctor and your baby's doctor about how you are feeling. They can help, but only if they know how you are feeling. Your hormones will get more in balance each day ... Take care The first three months are tough going!

I am sorry that you are having such a difficult time. I know exactly what you are going through. I gave birth to my daughter via c-section 4 months ago. I was anxious that my daughter wasn't getting enough to eat. She cried a lot and I got no sleep and didn't eat. Exhaustion and loss of appetite affected my milk supply, and it was a vicious cycle that I found myself in. We ended up supplementing with formula at night and my husband woke up for one night feeding so I could get at least a 4 hour stretch of sleep. Sleep is very important and is key to overcoming postpartum depression and keeping up your milk supply.

I highly recommend reaching out to your doctor to get medication for depression/anxiety. Zoloft is safe to take while breastfeeding. Initially I didn't want to take Zoloft, but things weren't getting better for me. A nurse practitioner spent over an hour with me talking about the pros and cons of Zoloft and she said that it is a necessary medication for me, no different than if I had high blood pressure and was prescribed medication for it. That really resonated with me and I started taking it. It has helped me tremendously and today I'm enjoying everything about being a first time mother. Looking back I really regret not taking the medication sooner.

I also recommend taking daily breaks away from the baby, i.e., some me time. This is similar to taking breaks at work. If you don't take breaks, you will not be effective at work. But more importantly, take breaks and do things that make you happy. Get a massage, go for a walk, etc.

The last bit of advice is not to stress if you need to supplement with formula. I felt a tremendous amount of pressure to exclusively breast feed and this caused me extreme anxiety. I learned that it isn't the end of the world. Your baby is satisfied and sleeps longer, you get a break and some sleep. Remember, a happy baby = a happy mom and a happy mom = happy baby. I do a combo of breast milk and formula today and it works for us. Good luck to you. Feel free to email: jntkim [at] yahoo.com. happy new mom

Oh Mama! It gets better! I has my baby via csection 4 weeks ago and breast feed exclusively. Has your milk come in yet? With c-section it can take a bit longer so your baby might just be getting colostrum and needs to eat often. They have tiny stomachs so frequent feedings are required Every 2 hours is rough, but you will need to feed baby every 3 hours for a while. Sleep is dictated by baby's schedule, so sleep when baby sleeps. I use the moby and was able to use it pretty quickly after my csection ( I healed pretty quick)...this swaddles baby and allows you to do other things. I even sleep with my baby in the moby. I out a pillow to one side; lay the baby on the pillow while we are still connected via moby and he sleeps great in there, and I do too. He's close by and Incan feed him right away when he wants to eat ( which is still every three hours). Also. Get your partner to take baby after a feeding for swaddling and diaper changes so you can rest. I did not change a single diaper until my son was three weeks old. Stay super hydrated to and make sure to rub pure lanolin on your nipples. The last thing you want is to be tired and have cracked nipples!! Watch the baby blues and have your partner watch too. Post parfumerie depression is very real. Try to keep it in perspective if you can: your new love is so little he needs you for everything. You are bonding with your baby while you breast feed, it's the best food for your baby and eventually your baby will be able to go longer between feedings. Nap when your bay naps, limit your visitors to 20 minutes each ( a long visit from someone means you miss a nap), don't do anything by feed the baby and nap/rest, get your partner to do everything else, and maybe give yourself a positive mantra ( such as '' I love my baby, I can do this''). My baby loves to be swaddled too, it's hard to get the hang of it, but it will become second nature soon enough. Good luck to you mama! Hang in there! new mama

Hang in there! Your situation sounds almost identical to mine. The first two weeks were HORRIBLE for me. I had the c-section, horrible constipation (I know) and I was suddenly extremely sad about the fact that my husband and I were no longer a ''just us'' relationship. I also had to supplement with formula and felt guilt about it. My daughter wriggled out of swaddles, I didn't feel like I would ever get it right - which was extremely frustrating because she calmed down when we could do it tight enough to keep her in. (seriously strong baby.)

My advice is to get a ''miracle blanket'' right now. It's safe - there's no velcro or anything, but it doesn't require anywhere near the amount of sophistication that a regular swaddling blanket does. The wrap is very tight and a little baby, no matter how squirmy, won't be able to get out. We also followed the Happiest Baby on the Block steps stubbornly - 40 minutes of rocking and shussing to get her to sleep sometimes - but after a couple of weeks of that she became, and still is, the best sleeper of any baby we know. Expect to be bummed for a little while. This is a huge change and your body has been through a massive trial. As my mom told me, each day you will feel a little better, until you feel good again. Try getting out and walking around the block. IT will hurt, but you'll feel better after. If you're still super bummed at 3 weeks, go to the doctor. I would also be happy to talk to you anytime, please get my email from the moderator if you want. back to normal

I also had a c-section and a really rough time of it in the hospital. I had to stay 3 days (2 nights) and they made me start giving my daughter formula which I was really against but they showed me that she was ''too hungry''. She may have been, but in hindsight, several of my friends that had vaginal births and went home right away had their infants lose just as much weight as mine and then gain it back as they hit their stride in the next 2 weeks. But the staff (Oakland Kaiser) had me so distressed about not being able to feed my baby, etc etc that I went through emotional hell. Even after we went home it continued in the form of daily weighings and visits with lactation consultants. My husband finally put a stop to it and said no more weighings and we stopped going to lactation. Things got better but I had already started feeding some formula and I HATED pumping. Hated it. My daughter nursed well and also drank well from her bottle. She didn't end up confused and I'm happy about the way it worked out as papa got to feed her more. I wish I could have nursed exclusively, but it just didn't work out for us. She weaned herself around 11 months and has been a healthy weight since 3 months. Anyway, I don't really have too much advice except maybe let her drink some formula or pumped milk so you can stop worrying for an hour or two and get some sleep. I chose the Baby's Only 'toddler' formula as it is the only organic formula without the synthetic DHA ARA added to it. Rachel

I feel your pain! I went through postpartum depression, exhaustion and sleeplessness after my second child was born (and I had an easy birth, not a c-section, so it must be even harder for you, poor thing!!) I hope you don't mind advice from a non-c-section mom who was crying almost non- stop for the first three weeks after my second. First thing you must realize: this is temporary and things will get better, I promise you! 1) make sure you eat enough. Part of the reason I couldn't sleep at all when I had the chance was because I wasn't eating and my blood sugar levels were too low, and they would really crash after nursing. My solution: I drank a cup of Odwalla protein drink at the beginning of each nursing session. This assured that my blood sugar levels wouldn't crash and helped me to get a little more sleep. 2) I called my OB and got a prescription for zoloft which really helped my depression. It's safe while nursing and you can wean off it later when you are feeling better. Make that phone call NOW! 3) My baby would only sleep on me and never on her own. I found out that she would sleep longer on her own if she slept on her stomach. I figured we weren't in a high-risk group for SIDS and I was EXHAUSTED so I put her to sleep on her stomach (next to me on the bed), and then I started getting more sleep. 4) I got help from friends for food, laundry, watching my older child, etc. If you have support, use it! Can someone take your baby for several hours in a sling and supplement with a bottle while you sleep for six hours? If so, do it! You said that you ''wanted to do it right this time''. Doing it right means taking care of yourself so you can be there for your baby. I was exclusively bottle-fed and I'm fine. Giving some formula will be OK so you can rest. Please do it. Anon

Dear exhausted new mama,

I truly feel you. I had very similar experience as yours. I had a long and hard labor which ended up with emergency C-section. Then the story was the same as yours: exhaustion, nursing struggle, and postpartum depression. I literally cried almost every day until my baby turned 3 months old.

I want to tell you that there is hope. Things got a lot easier after my baby turned 3 months old, when he stared to sleep through the night. My baby is now 14 months old, everything is becoming easier and easier and more and more fun. My baby makes me laugh many times every day, and I am so much enjoying the motherhood. Looking back, I felt those hard days were so short and time was flying by so quickly. All those hard work, including the depression and sleepless nights, are totally worth. Now to answer your questions:

1. To swaddle your baby, try HALO 100% Cotton Sleepsack Swaddle, which you can find on amazon: http://www.amazon.com/SleepSack-Cotton-Swaddle-Cream-Small/dp/B003E6OBMA/ref=sr_1_1?ie=UTF8=1348681740=8-1=halo+swaddle+sleepsack This swaddle can be used with arms in or arms out. I did not get this for my baby, but I really wish I did.

2. The sleep issue - Have you thought about hiring some one to help you? The first two months are the hardest, and if you have a little savings in your account, I think it is very worth to use that money now to get some real help. My parents were here to help me during the first two months, and I would have not survived without their help. You can either hire a daytime or nighttime nanny. You can pump and store your milk ahead and let the nanny feed the baby, and then you can have a longer sleep.

3. Is it possible for your husband to take a few weeks off from his work? Even 3 weeks will help tremendously. If he can, you can let him take care the baby at night so you can sleep. If he regularly takes vacation every year, why not taking vacation now to help you when you truly need help?

4. Do you have any relatives that may be able to offer help? Your parents, or in-laws? If they have the time but feel reluctant to have to work hard, you can hire a nanny to do the hard part and ask your relatives to just help to watch the baby.

I am so sorry for what you are going through. It is very hard, but there is hope and very soon (in a couple of months) you will feel things start to get easier and easier. once a depressed mom

I'm so sorry you're having such a hard time. There's nothing worse than not being able to get sleep and that can absolutely trigger depression. Here are a few thoughts that I hope can help: Buy a miracle blanket (or two!): http://www.miracleblanket.com/ This worked wonders for swaddling our baby- it was like a ''baby straight jacket'' (but in a really sweet, cozy way). We couldn't swaddle her for the first month or so and then our friend told us about this and everything changed. Also, if possible, get some help. If you've got friends/family who are willing/able to help out, then have someone set up a ''meal train'': http://www.mealtrain.com/ or ''Lotsa helping hands'' http://www.lotsahelpinghands.com/. For a meal train, people sign up to bring you meals. For ''lotsa'' they can sign up for meals as well as anything else you specify, like taking your older child out to play or helping with the dishes or laundry or just watching your kids while you nap. If you don't have people who are able to do this for you, then I'd strongly suggest hiring a post partum doula. They're not cheap- usually about $30/hour, but maybe you could find a nanny who's looking for a few extra hours who'd be able to do it for less (like $15/hour). They could help with dishes, laundry, cooking and most of all child care so you can REST. Try not to worry about getting sleep every time- even just lying down and closing your eyes (with some white noise on so you can tune out sounds) will help. Drink water. Eat comforting food. And remember that it WILL get better. But don't be afraid to ask for help! There's a wonderful community of Moms who have at one point or another gone to pre or post natal classes at the Yoga Tree on Telegraph who have google group- https://groups.google.com/forum/?fromgroups#!forum/conscious-birth-community. If you join that, I'm sure there are people who would be willing/able to help and give other suggestions as well. Good luck! Been there- it gets better!

Dear Sleepless, How I feel for you! I went through the same thing with my son (born by C-section after 3 hours of pushing, *after* 26 hours of hard labor *after* several days of regular contractions). My son also didn't stay swaddled, yet woke up instantly if we tried to put him down. Plus, I wasn't able to get up from a bed unassisted.

Here is what I ended up doing: My husband set up an armchair and ottoman (feet up, with a support pillow under my knees). Before my husband went to bed (he couldn't help out during the nights because of a medical condition), he'd help me get in the chair. I realized I needed to hold my son close, and that, on a nursing pillow, he'd snuggle up to me and sleep peacefully for up to three hours at a time, sometimes longer. Skin contact with me meant that he didn't need to be swaddled. Throughout the night, my son would sleep and wake up once to nurse once in a while. I can't usually fall asleep sitting up, but I found that I was able to sleep, or at least get some rest, with my feet up and my son snuggling up to me. In the morning, my husband would help me lie down, and I'd often get some sleep in an actual bed for an hour or so. Of course, as I healed and was no longer in pain, and able to , things got much easier.

You sound like you are in a terrible, terrible spot, and you are so right about the cycle of sleeplessness and depression. Can you get someone to help out for 1 night, while you take a sleeping pill and get one night's rest? Marathon laborer

My sympathies -- my child slept just like yours, and it was really hard. Please do not assume that there is only one way to ''do this right''. If it is necessary to supplement with formula in order for you to sleep enough to get beyond complete exhaustion, then that is the right thing to do. My husband and I did the following. I had a really plentiful milk supply, so I would nurse my son from one side, and pump from the other every two hours. Then, I would go to bed at 8:00 pm and sleep until about 2:00. My husband (who is a night owl anyway) would feed the baby from a bottle each time the baby woke, until 2:00 pm. Then he would come into bed and turn on the baby monitor; I did the feedings after that (and my husband would sleep from 2:00 or so until 8:00).

That one stretch of 6 uninterrupted hours made all the difference in the world. You should try to work something like this out with your partner, so that each of you can get enough sleep to get by. It is more important that you sleep to the point that you feel rested, than that your baby gets only breastfed. Karen

Either pump or use formula so that your partner can take turns feeding the baby at night. You have to take shifts so that each of you can get some amount of sleep. It still won't feel like enough, but it will be better than the current situation. If you haven't already, see a lactation consultant to make sure that everything is going well with the breastfeeding. I did not have a c-section, but because my son was born with jaundice, we actually had to wake him up and feed him about every 2-3 hours so that he wouldn't need to be hospitalized. I breastfed and pumped so that my husband could take a turn, but if you can't pump then using formula for one feeding a night so that you can get 4 hours of sleep is okay - the baby will still be ''breastfed.'' It was pure hell, and I sympathize with you so much. I think a lot of ppd is sleep-deprivation. Get help with the feedings, and if you can afford it, looking into a post-partum doula to help you. And formula is not poison, so if you have to go that route to keep your sanity, please don't be hard on yourself. Good luck! been there

I am so sorry to hear that you are going through this! Sending tons of sympathy your way! It does indeed sound like a vicious cycle and it's good that you are out seeking advice to try to break the cycle. If I were in your shoes, I would contact a post-partum doula. They are worth their weight in gold, so if there is any way you can gather the money to hire one (or even just talk to one), a doula will really help you out. I recommend Blythe Lee and if she is not available, definitely keep up your search. There are tons of doula recommendations archived on BPN. Besides offering sage advice, a doula can come over and help you out as you transition into the demanding nursing schedule and to get sleep. It sounds like there is a certain level of anxiety that's preventing you from being able to get quality sleep, so you may want to do some web searches to help on that front. Maybe some meditation? Perhaps there are some holistic remedies out there to help you with sleep? There are various soothing techniques for babies who are fussy/gassy - you may need to seek out the right book. I actually just saw a book about this topic on the shelf over at BPL's central branch. I know you are incredibly exhausted, but do your best to keep up the fluids, avoid caffeine, eat well and nurse your baby. Nursing every two hours is very typical at the beginning. (Mine was more like every 1.5 hours.) Remember that the more your baby nurses, the more successfully your milk will come in. Supplementing with formula will indeed threaten your milk supply, so *if possible,* avoid that tactic. Contact a lactation consultant for help and advice. There are safe ways to do side-laying breastfeeding that will allow you and baby some quality sleep. Do not resist falling asleep while your baby nurses. These are the early days where you should be recovering and sleeping and definitely not worrying about any sort of sleep training techniques! (You probably aren't, but just in case, I thought I'd throw that out there.) Summon help and support from your community of friends - ask a trusted friend to set up a ''meal train'' for you and your family. Or check out lotsahelpinghands.com where you can specify your needs and what day you need them. Don't worry about etiquette: this is your time of need and your true friends will know/realize that you are in a place where you need the support. It's possible your friends/family do not know or understand what your family needs right now. You may need to explain the situation a little bit. Do all you can to zone in on taking care of yourself, which will, in turn, take care of your baby. wishing you all the best

I did not have a c-section, but I had to respond to your posting! The first two weeks after my daughter was born are both a blur and seared into my memory at the same time. Oh, the exhaustion and the hormonal waves of crying for no reason! And breastfeeding was still very much a trial and error situation. What you are describing sounds so familiar that my first reaction was to want to give you a big hug and tell you to breathe. You and your baby will figure out what works for you and you will get sleep again.

To address some of the details you brought up: Feeding every 2 hours sounds about right to me. At night we were able to stretch it to every 3-4 hours, but during the day our daughter definitely fed every 2 hours. I am not good at napping during the day, but I would try to rest when she did, and at night I was so tired I usually fell asleep as soon as she was done eating. Worrying about supplementing with formula: You mentioned that this time you want to ''do things right'' and I applaud your commitment to exclusively breastfeeding. But I also want to encourage you to ease up on yourself a bit as well. This added pressure is probably adding to your restless brain, which is keeping you awake. Go see/call a lactation consultant and discuss your previous breastfeeding situation and your current goals. They should be able to help you. At Kaiser we had a LC appointment a week after our baby was born and she was very helpful in tweaking positioning and whatnot so my baby could nurse more efficiently, as well as easing some of my anxieties about ensuring she was getting enough food.

Please take care of yourself and allow yourself to have the spontaneous crying jags and the feelings that you are doing it all wrong, but always remember that you and your baby will figure out a rhythm and it will get easier. Maria

Buy, borrow, steal (just kidding) a Miracle Blanket. It's like a straight jacket and totally works! My 3 kids were professional escape artists, but couldn't get out of this one. We used it until they could flip over in spite of their protests. My first especially was so flaily that he would wake himself up constantly and NO ONE was getting any sleep. I would simply swaddle them in the MB, nurse them to sleep, and then slip them in the swing and turn it on low along w/some white noise. Then they would do a good two hour nap. It really got us thru the first (crazy- making) 4 to 6 months or so. Good luck! Been there

Our baby loved his true womb! It's a fancy swaddle with velcro that baby can't get out of. http://truewomb.com/ That and co-sleeping really helped us get through the early weeks. I hope you all find something that works for you soon. kate

My heart goes.out to you. Those first weeks are sooo hard. I think everybody blocks the memory out and pretends it didn't really seem that hard. I had terrible nursing issues which were not sorted out for six weeks. I could not sleep during daylight hours and was so sleep deprived. Plus I had separated my pelvis during birth and could barely walk. Not the same as a c- section but challenging. Please hang in there! It is gonna get so much easier. Really quickly your baby gets stronger and better at nursing and much quicker at it too.

Your hormones will settle down and your body will recover and every day it will be easier. My baby is six months now and nursing is a joy, not the torture it was at first. It is so lovely to be close with my babe and no washing bottles or buying formula. You can do it. Get a lactation consultant you like. Go to la leche or other meetings to get moral support. You deserve cheerleaders. Nursing is hard but so worth it. was depressed and exhausted too

Hang in there. Everything gets better, very slowly. Your baby is brand new in the world and needs to be held. Mine needed to be bounced in our arms to sleep (and then held in our arms to stay asleep) for more than three months. And as a newborn, mine nursed every 45 min. It was crazy- making. I wish we had asked for help (perhaps holding the baby) from friends or hired someone. I cried every day and did my best. It was grueling, truly grueling, but it gradually got better. You will sleep again one day!! And your child will thank you for all you've given. I have the most amazing relationship with my awesome school-age child, and it all began in those very hard early days, months, and years. Get help, stay strong, listen to your child, and know you'll get through this. It was worth it

I had a C-Section after a 47 hour home labor went south, and here's what I learned after the fact:

1) C-Sections disrupt the bonding hormones- so your child may feel more like a burden than a blessing. This is not all in your head. Don't blame yourself and make it worse. Blame the drugs, and know it will get better.

2) Depending on your metabolism it can take four to six weeks to flush the drugs from your system. These drugs gave me hallucinations and night terrors so that even when I could sleep, I wasn't resting.

3) Newborns come in many varieties, and mine slept for less than 2 hours a night to start as well. BUT- if it takes an adult four to six weeks to get the drugs out of her system, then doesn't this affect the baby? And if I'm troubled by night terrors, then could baby be experiencing something similar that is interrupting her sleep patterns? No doctor could answer this for me.

4) I had to allow myself time to grieve for the home birth experience I lost AND to process the body/mental trauma of being cut open. This is not a paper cut.

Suggestions: Nighttime dula, daytime dula, massage therapy, acupuncture, reflexology, chiropractic treatments, gentle herb cleanses and relaxing tonics/teas, warm Epsom salt baths, with lots of swaddling, rocking, and comforting for YOU- not just baby. Big C Mama

Hi there, I know exactly how you feel - I was exactly where you are (not the same circumstances, but emotion-wise) just a few short months ago. And it is so hard to find your center and to be present, even for yourself, let alone your new baby, when you are so exhausted. Do you have partner support? Family? Close friends? Now is the time to draw upon those resources if you do have them. They can't breastfeed the baby for you, if that is what you choose to continue doing, but at least they can just be there with you to help you through, to make you food, etc. The first 6 weeks of nursing are sooooooo intense, and while I hated hearing people tell me this, just know that it will get better, because she will change, and you will change, as we all do. It is so hard in the moment to moment of it, but I can tell you that things did begin to shift at around 6 weeks (I know how far away 6 weeks sounds, but look, it's already been a week since you wrote your post!), and now we are nearing the end of our 4th trimester (she is 3 months tomorrow), and while it is still exhausting, consuming, and so so hard, there are at least some bright spots and some respite in the mix. If you are a group person, please also consider finding a support group near you. Feel free to get in touch with the moderator to request my email if you would like to reach me. Sending you much support and empathy. Rachel

I'm glad you're swaddling-- this helped our baby to sleep SO much better. I highly recommend one of the swaddles with velcro tabs like the Swaddleme ones made by Summer or Kiddopotomas. These were a lifesaver for us-- especially for allowing the baby to sleep without wrangling an arm free that would then wake him up! I'm sorry things are so difficult right now-- it will get easier, I promise. Huge fan of the Velcro swaddle!

Take a deep breath, everything happening to you is normal just a very different kind of normal. My partner saw this ? and emailed me right away because it is like a note out of my baby book. Our baby also didn't like to have her arms swaddled, what can you say, you have a free spirit baby! I too had a C-section. It took 2 weeks after the birth to begin to feel normal. #1 Get help doing everyday things. I had in-laws who came over everyday to help (clean dishes, hold baby, make dinner) I hope you are using all available resources right now. This is a time when ppl tend to sit back until called upon so make some phone calls if you don't have help in the house. You need to be honest with yourself about needing help right now. #2 Pump and let someone else feed. I used a SMS system for feeding our baby. They carry them at Baby World on Telegraph Ave. It is a little bottle with a tiny tube attached. You tape the tube to your finger and the baby sucks on your finger while getting milk. The SMS doesn't not interfere with nursing the way a traditional bottle does. This way you can pump lots of milk, fill the bottles with a couple ounces and assign someone else to feed baby on the 2 hour cue. Meanwhile you can sleep for a few hours, baby gets fed and you haven't had to pull out a ''real'' bottle. Our nurse said we could reuse the SMS (they cost around $20) cleaning the pieces with gentle soap and rinsing out the tube with water (no soap). #3 Sleep. It is okay to take Tylenol PM when you need to sleep and someone else is feeding baby. Ask your doctor if you are unsure about it. I used it a couple times to help me get a few hours in a row of sleep. A single glass of wine is okay too as long as you don't feed baby right away. #4 Formula is not evil. If I could do it all over again I would have had a bit of formula around to make certain my baby was getting enough nutrients in those first few weeks. The only other alternative is to pump pump pump. I hope this helps along with all the other advice people will send you. I too felt very sad and weepy after the birth. The C-section takes a toll on you. BTW... A little talked about side effect of a C-section is that it is normal to one day stand up and have a scary amount of red-tinged liquid seep (...more like a faucet turning on) from the wound. When it happened to me I first thought I had wet myself only to later discover most of my friends who had c-sections experienced the same thing. Good luck!!! Lisa

Hey - it gets better! Seriously! I've been there c-section and all, and I understand the mix of emotions & hormones & pain, and being sleep deprived on top of it only makes everything worse. First for swaddling - buy a Miracle Blanket - seriously, these are the BEST! We tried swaddling and could never do it right. Our daughter would just wriggle right out of it, but the Miracle Blanket solved that problem, and is easy to maneuver in the middle of the night on no sleep. She quickly started sleeping longer and better. For YOU - take any help that you can get. Even getting friends or family to come over to hold the baby between feedings for an hour or two so that you can get some extra sleep will help. And sleep is truly part of the road to recovery. I don't know your thoughts on c-sections or if you are also dealing with the extra emotions that come with it, but the emotional part also gets better. Talk to friends or find other people who have had a c-section about it. It helps. So many people, especially in the Bay Area, are so judgemental about them, referring to it as ''birth rape,'' etc, and don't understand how hurtful and misguided their statements can be. In truth, a lot of them are trying to be helpful, but you don't really know what it's like unless you've been there, so find people who have been there and talk to them about their experiences. You'll find that you are most definitely not alone. Anyway, HANG IN THERE! And definitely make sure that you take time for yourself. Shower everyday, make sure you're eating and resting, etc., and when you feel up to it, make sure you get outside and go for walks or whatever. These things sound basic, but they really help. Good luck! It's not always easy, but these first few weeks are definitely the worst. M

My heart really goes out to you, mama.

(1) If you are in physical pain post-surgery, take pain meds. Talk to your doctor, of course, but there are many, many options you can use that won't interfere with nursing or harm your baby. You do NOT need to live in pain. And if you are not yet moving around very easily due to the C- section, you need another adult to stay with you during the day. Your husband, your mom or another relative, or hire a post-partum doula. Do NOT be shy about getting help!

(2) It is NORMAL for babies to need to be held constantly 24/7 at first, and to nurse almost constantly too. (Nursing ''every 2-3 hours'' is an average, not a schedule; the actual intervals might be longer & shorter.) Please adjust your expectations! You don't need to put your baby down; you need to figure out how to meet her need for physical contact in a way that balances the physical & emotional needs of yourself and the rest of your family. Babywear. Cosleep. (Nursing, bedsharing new mothers get more sleep and feel MUCH more rested than bottle-feeding moms with crib-sleeping babies.) Spend more time in bed; it *does* help stave off exhaustion. Take advantage of every possible opportunity to let loving friends and relations hold the baby while you nap or shower or play with your firstborn. Somewhere between 4 & 12 weeks, your baby will begin to develop a more regular sleep pattern and to be more content to sit in a bouncer seat or the like on her own for longer stretches, and you will begin to emerge from the fog.

(3) It's also normal to be weepy in the first few weeks after giving birth; that's your hormones swamping your good sense. You will survive! Breastfeeding and babywearing help *reduce* the risk of post-partum depression, so don't be tempted to formula feed or sleep- train in order to get more rest; besides the associated risks to your baby's health, it wreaks further havoc on your hormonal balance. Get help with household maintenance and anything else you may be feeling responsible for; right now you are entitled! Recovering from birth and caring for your new baby are tiring under the best of circumstances. But if you don't feel like the ''baby blues'' are passing soon, or after another week or two you still can't sleep more than an hour at a stretch even when your baby is slumbering quietly in your arms, seek medical help. Post-partum depression is nothing to mess around with, and if you need a good counselor/therapist/psych, the sooner you see one the better off your whole family will be.

My very best wishes for a speedier recovery and a happier ''babymoon'' to you. Holly

Dear Exhausted, I would be too. Nature never expected women to care for a newborn without a lot of help, but our lifestyle with minimal extended family puts us in a bind. What are your resources for help? Can you afford or get gift money for a post partum/night doula? Can your husband/mate give you at least one nap a day with the baby out of the room and sleep with the baby at least part of the night and bring the baby to you to nurse? That is how you get dream sleep that keeps depression away. In studies, mothers who had someone bring the baby to them at night to nurse had no post partum blues or depression. We have forgotten that traditional cultures do this all the time in the first two weeks.

Newborns sleep best swaddled with their arms straight at their sides to mimic the uterus. It's not a preference to have their hands at their mouths, it is just that the pelvis has kept them there for weeks and they tend to rest there. A great swaddle blanket you can get on-line is called ''the miracle blanket'', with velcro for the wrists. Parents swear by it. Please get some sweet dreams. midwife Lindy

I didn't read the original posting so I hope my reply is relevant . It looks like most of what I would have advised has been covered in previous responses, but I wanted to add this: I used Alta Bates' breastfeeding support group, and specifically there I worked with Ann Hauss, who is ABSOLUTELY PHENOMENAL!!! We have three kids, the first one was born in Boston, and things were horrible. Horrible Postpartum Depression for a year and a half, baby wouldn't breastfeed, pumping, no sleep, unsupportive OB, incapable lactation consultants, did not bond with baby - you name it. I am absolutely certain that if I had had someone like Anne there with me things would have been (and would be, as I am still struggling to bond with the now 7 year old) different. Ann will never pressure you to do anything that will lead you to be dependent on the pump (and will lead her to make a sale for Medela). I'm not kidding, I had the head of the breastfeeding department throw her hands in the air at the hospital and exclaim that the baby will starve if I don't pump NOW (my milk hadn't even come in yet). Fortunately this was with our third kid and I knew she was BSing me. Ann will also never get your baby to breastfeed and then leave you to your own devices: she will help you get the baby on, then take him or her off, and have you repeat putting baby on until you CAN DO IT yourself! And she has infinite patience and compassion. AND she is basically available anytime you need it: through her groups at Alta Bates, through individual appointments at Alta Bates, and via house calls. If you feel you need support, PLEASE give Ann a call. Been there...

I had terrible insomnia in pregnancy and then for the first 2 weeks of my son's life. The insomnia fortunately switched itself off, just when I couldn't stand it anymore. By week 2, I was able to sleep whenever our baby would let me (usually 2 hrs. at a time). Now, at week 9, I occasionally get a 4 hour stretch. I can't express how amazing it feels to get that much sleep in a row! Everything is easier and better now, and I have no doubt things will continue to improve in this regard - for me and for you! Hang in there. You are stronger than you think and everything WILL get better. Sarah

This is the time to call your support system. I assume that your husband is at home with you, and is cooking for you, and taking care of the house. You are supposed to just lay in bed for this time. Just lay there and sleep when your baby sleeps. You will also learn how to nurse while you are asleep. It's called side nursing. I am not sure if you have doula, but if not and can afford $50 an hour, then call http://www.esthergallagher.com/. I went to four doulas and several breast feeding specialists, for help with breast feeding and she was the only one that helped. I am not sure if she will go to the East Bay, but if not, she might know someone who will. Friends should bring you food, hold your baby, and let you sleep. Take Iron. I took the edible liquid kind, don't know what it's called. Eat meat if you can. and now I am going to shout: THE MOST IMPORTANT THING I LEARNED ABOUT BREAST FEEDING, WAS THAT IT'S IMPORTANT TO RELAX. This let's the milk down, and lets your baby drink. My guess is that you have people that would love to help, but need to be asked. Good Luck

Postpartum depression and Medication -breastfeeding, thinking about getting pregnant

June 2006

I have been suffering from PPD for about 5 months but did not want to start medication becasue I was breastfeeding. It has gotten so bad that I need to do something. However, my husband and I also want think about having our second baby when our daughter reaches the one year mark (about 3 months from now) IF I am doing better. Has anyone been on antidepressants while nursing and/or duringpregnancy? Any info on how to deal with PPD would also be helpful. Thanks Krista

Seems like you should resolve your PPD before you even start to even think about another child. Pregnancy will probably just worsen things. Get a good psychiatrist who is used to working with nursing moms. Then once you tackle that, talk to your psychiatrist AND OB about what you should do for #2. Personally, I have gotten off meds prior to conceiving every time but that is a decision you and your docs should make. Fellow PPD sufferer.

As someone who has experienced episodies of major depression for much of my life, I took antidepressants during both my pregnancy (Celexa, then Zoloft) and post-partum period (Paxil). I nursed/pumped for a few weeks after my son was born but a combination of my PPD and latch problems cut short my breastfeeding plans.

For me, I had to weigh the risks of SSRIs against the risks of being depressed during pregnancy and after my son came. My depressions are so debilitating, and so interfere with my ability to be a decent parent, that for me, using medication was absolutely the right choice. (I also did and do other things to try and minimize the risk of relapse, including meditation, exercise, healthy diet, etc.--but none of these alone were enough to overcome my vulnerability to depression.)

A good source of information about the safety of antidepressants (and other medications) during pregnancy is the California Teratogen Information Service at UC San Diego (http://ctispregnancy.org or 800-532-3749). You can call them and they will give you up-to-date information about the safety of different drugs during pregnancy. I used their service to aid my decisions, and even enrolled myself and my son in a longitudinal study with them. (BTW, my son is now 3 years old and is generally healthy and developing normally.)

CTIS also gives limited information about medications and breastfeeding but a good source of information about the safety of medications during lactation is Hale's book Medications and Mother's Milk (which any lactation consultant should have and can go through with you). I believe he also has a book written for parents. His website is http://neonatal.ttuhsc.edu/lact/index.html. Be well and take care of yourself K.D.

I nursed my daughter for three years and my son for 20 months while on Zoloft. PPD is a serious disorder and the ''side effects'' can be detrimental. I did a lot of research and felt convinved that Zoloft was safe for me given the risks to myself and my children without treatment. While pregnant with my first, I did try lots of alternatives to meds, because of course I was concerned with the health of my children. However, I have major depression- the type that doe not generally respond to herbs and other non-medical treatments. I credit Zoloft with saving my life and possibly my children's lives.

Please talk to your doctor and then call Shoshana Bennett (510) 704-0359- she is an expert in the area of PPD and can offer you a ton of research and resources anon

I had PPD with my first and I know what you're going through, I'm sorry you've had to suffer with it for so long, mine only lasted for 6 weeks because I chose to stop nursing and start taking Prozac. When pregnant with my second, I stopped the antidepressants but shortly realized that my brain was not okay with that, and when things once again started falling apart, I went back on but switched to Zoloft, since it's the only SSRI that's been studied in nursing women and has been shown not to pass into breastmilk. The problem with medications and being pregnant and nursing is that there are so few studies out there, (because who wants to make their child a guinea pig?) which leaves us with very little substantial information about whether or not they're okay to use. So doctors will use the risk v. benefits approach: knowing what you know, which is admittedly little, do the risks of not taking the drug outweigh their benefits? In my case they did, so I took them, and am a MUCH happier person for it. You need to figure out which option is going to work for you.

As for the PPD, again, I'm so sorry you're going through this. You need to have a safe place where you can talk about how you're feeling, whether or not you choose meds. Studies have shown that when women talk to other women, the hormone oxytocin is released, which has a calming and uplifting affect on the brain. Find a support group and/or find a therapist (Alisa Genovese, 286-7599, she's the BEST!) You have to talk about what's going on, even if you already are, you need to do it more! Feel free to contact me directly if you have any questions or want to talk more. Jill

Hey Krista, I waited until my daughter was 10 months old before taking antidepressants, because I was a little concerned (and my spouse was totally paranoid) about the drugs going into the breast milk. I'm sorry I waited so long. What a relief a little Zoloft can give a person! It's like I got a whole new life. I stayed on it, on a reasonably low dose (about half the average daily dose), throughout my pregnancy with our second daughter, with no ill effect. I missed a lot of joy when my first one was tiny, because everything was so hard and I was having so much trouble managing. But with her little sister I've been laughing since day one. Now I have no intention of ever not taking Zoloft, or whatever they come up with next. My glass is half-full instead of half-empty pretty much all the time now, and that's the best thing I can give myself and my family.

Get on the drugs. The impact of mommy feeling good again will be incalculably positive on your child, and far outweigh what little chemicals are being passed on in your breast milk.

Consider giving yourself more time before getting pregnant again. Allow yourself to celebrate your daughter's birthday and think about how far you've come. Give your body time to figure out what drugs you need to take, and how much, and give yourself time to stabilize without a biological deadline pressing you. Enjoy yourself again. Pump a few bottles and take a night or two away from your family (yes you can!). And bear in mind, though you've been told many times already, that two kids is way more than twice the work of one. The difference to your fertility of waiting another year might not be an issue, but the difference to your emotional and physical readiness for handling the stress could be tremendous.

Consider couples counseling. It took another year after I started taking the drugs before I figured out how to articulate how ANGRY I was about a whole bunch of stuff at home and how SAD I was about my old life/self being gone forever. Giving those feelings voice made them less imprisoning, and things are still very hard, but now they are just ''things,'' not everything.

Hang in there! heidi

I have been there, not that any two cases of PPD are exactly alike. I was completely against taking meds, and spent months trying all kinds of natural stuff, all to no or little avail. I finally yielded because the situation felt much too desperate. I went on a very small dose of ZOloft (took 1/2 of a 50-mg pill), and felt results within days, literally. I read as much as I could about the effects on nursing babies, as I really wanted to keep nursing and didn't want to harm my child. I didn't start taking the meds until my child was 9 months old. But in hindsight, I should have started earlier. I mean, I was so miserable, and I think that affected the whole family much more than some residual SSRI. That being said, I read something in the past couple of months about a study that did indeed show that breastfeeding infants do get some side effects. I think the study focused on Paxil, though, and I am not sure of the ages of the babies. I know that, at this point, Zoloft is believed to be the safest.

I also feel that doing talk therapy in conjunction was crucial for me. As for wanting to get pregnant again, hat's off to you. I can't imagine, in the midst of the PPD, having that desire AT ALL. Perhaps that's a good sign. It would be good to get info on the effects on a growing fetus, however. Also, be warned, it's very common for your sexual libido to disappear. Good luck to you. PPD is no fun. Mom who has been there

I urge you to think long and hard about the decision to have a second child so quickly. In the best of circumstances, it is incredibly stressful to have a young child--to have two in diapers, even if you are feeling well, may be asking for trouble. Could you wait another year or so? anonymous

I have 2 children spaced 22 months apart. After my first was born, I was euphoric, full of energy and couldn't hardly wait until I could have another. After my second was born, I had a series of minor complications and a major problem with PPD. I'm not medicated and have no comment to make there. BUT, I can say that having a second child so soon after your first, even if you're feeling great before you get pregnant does not bode well. Two children as stressful -- even if they're both really great babies (sleep all night from the beginning, no colic, rarely sick, eat well, happy) as my two kids are. PLEASE think of your child and future child. They require all that you have to give. With PPD, that's quite limited. Fortunately, my husband has been able to be home a lot, which has helped me come to the surface and I'm starting to feel better after nearly seven months. If I could do it again, there would be a MUCH greater space between my kids. anon

Breastfeeding and Exhaustion & Depression

April 2005

I am wondering if weaning my 18 month old would increase my energy/mood levels and get my hormones back on track (I know weaning has its own hormonal issues!).

I am suffering from chronic exhaustion (sleep deprivation, along with the demands of caring for a toddler and my older school-aged child), depression (major, for which I am taking meds), and major hormonal swings which really got worse once my period started when my son was 13 months old.

I nurse my son when he wakes at 5:30am, then before he goes down for his nap and then again before bed.

I am hesitant to wean because I do enjoy the connection with him and he certainly enjoys it. However, If I knew for a fact that weaning would improve my energy/depression, mood then I would be willing to do it. I just don't know whether weaning will make enough of a difference or whether I should focus on other things to address these issue: like exercise, vitamins, etc. I am 42 and wonder if my age is also a factor in why I am so tired.

I would love advice/input on the connection between breastfeeding and energy/hormones/mood levels. another tired mama

Weaning, by itself, isn't likely to result in your son sleeping later in the morning, and weaning a toddler who isn't ready to be weaned is exhausting. Especially at 5:30 a.m. So I think perhaps you should explore other avenues first! Mom of one weanling and one nursling

I breastfed my girl for 12 months and my boy for 9 months. I was glad to do it, but also very glad when I finished - especially with the second. I felt so much better physically when he was weaned. My energy level definitely improved (FYI,I weaned my son when I was 39). I woudn't say my mood changed much. And frankly, I think my son prefers a bottle. I too thought he'd miss breast feeding, but I don't think he has for a second. anon

First, let me say that you have already done a WONDERFUL thing by nursing for 18 months! You deserve a giant pat on the back for that!

I don't know for sure that weaning will directly affect hormone levels and depression, but I do know that eliminating the 5:30 a.m. feeding will! Can your husband/partner give him a bottle so you can sleep a little longer? If you could get him down to one feeding per day, preferably before bedtime, I think it would make a big difference, while still allowing you to keep that special connection. I nursed (and pumped) exclusively til my son was 12 months, and then my supply ran low so I cut back to just the one evening feeding. (I added rice milk because he is allergic to dairy and didn't like soy) It was a nice gradual way to eventually wean at 15 months (i had very little milk left at that point), and though it was bittersweet to stop, I felt like we were both prepared because it had happened so gradually. I was 41 when that happened, and I do believe age has something to do with it. There is a reason people do this in their 20's! I battle depression also (but I did before and after baby), and I would guess that perhaps weaning would have some effect on the way the meds work.

Give yourself some slack--you've done A LOT! Three times a day after 18 months is a tough pace to keep up. And it sounds like you are a SAHM too--which is also more exhausting than working away from home! Try eliminating the a.m. feeding for a week or two, then the mid-day one (assuming you can pump or that he can take a bottle of another kind of milk), and I think you will feel worlds better when you are down to one feeding at night. best of luck! anon

Hi, Wow, I feel for you! I wanted to write you back because in my case, while I LOVED nursing my daughter and had initially planned on doing it for at least 18 months if not longer, I had to stop. I stopped because of exactly what you are describing - exhaustion and depression - when my daughter was about 11 months old. And you know what? I felt SO much better in about a month. It made a HUGE diference to my body. Been there

After recently weaning my 15 month old my moods got worse not better. It's been about 3 months since then and I am starting to get used to the ups and downs of a the monthly hormonal cycle and mood swings. I must say it took me by surprise to be so subject to the power of hormones again. Things I took for granted, like good skin, are now gone. And I've put on some weight. My exhaustion is about the same. I have struggled with depression in the past, but the last few years have been depression-free and I continue to feel stable in that way. I don't want to discourage you from weaning--I have no regrets. Weaning for me was somewhat symbolic of my readiness to put my needs back on to the priority list. That felt really good. My connection to my daughter is as strong as ever. I was nursing about as much as you are and then cut everything out but the night time feeding. We did that for about a month and then stopped. She was fine with it. My advice is to cut out the 5:30am feeding TOMORROW. See how you feel in a week or two and take it from there. In addition, make more time for yourself and get some kind of exercise every day. I think this will do more for your exhaustion and depression than anything else. It's so hard, I know. In the same boat

breasfeeding made me exhausted. I feel much better since I weaned at 13 mos. sad, but true.

You should see a doctor and get some blood work done. I too was EXHAUSTED when my baby was that age and also slightly depressed. I became pregnant again and when I had my labs done I discovered I was very anemic. I think this is common if you are breastfeeding but not taking prenatal vitamins for the extra iron. Anyway, I went on iron supplements and increased my iron content in food and started cooking in cast iron and my energy and definitely my mood got much better.

Anemia can cause depression and it certainly causes sheer exhaustion. Right before I was diagnonsed I was starting to realize something was really wrong because I would get out of breath from the easiest task. My husband kept saying I should see a doctor and I said ''oh it's just from taking care of a toddler...'' He was right and I was stubborn. anon

I would like to give my experience here. I got very depressed AFTER weaning my two year old. Our bodies produce a hormone called oxytocin (sp?) when we beastfeed that makes us (mama and baby) feel euphoric. I went through a couple months of ''withdrawl''. Just another perspective. sad weaner

Paxil while breastfeeding

Aug 2004

I am wondering if it is safe to take Prozac while I breastfeed my newborn, or if there are other similar drugs that might be a better alternative to Prozac. Any information, links to websites or personal experience about this would be more than welcome. Thanks

While I am not a psychiatrist and do not prescribe medication, I am a psychologist who works with women experiencing postpartum mood disorders. I strongly encourage (all) women to educate themselves about their mental and physical health in order to make the choices that are best for them. You may find the following website helpful: http://www.womensmentalhealth.org/topics/breastfeeding.html. It is the website for Massachusetts General Hospital's Center for Women's Mental Health and is a good resource for all women (it has information on PMS and on psychiatric disorders during pregnancy, postpartum and during menopause). Be sure to also click on the ''Frequently asked Questions'' and ''Visit Our Women's Health Library'' sections for more information.

Recently, NPR had a story on postpartum depression and medication which can be found here: http://americanradioworks.publicradio.org/features/maternaldepres sion/index.html. The story featured Lee Cohen, M.D., who is at Mass General and is a leading researcher in the field of postpartum depression and medication. I also encourage you to talk to the health care provider who is prescribing the medication about your questions and concerns. Good luck. Mirjana

Thanks to the support of this network I decided to take an anti-anxiety med and it has made a HUGE difference. I am now feeling quite HAPPY and fulfilled as a new mom (it took about two weeks to kick in). Zoloft is the first drug of choice for nursing mothers, but I believe prozac is the runnner up.... see Dr. Sears baby book for more info. - happy mama

A friend of mine is just now completing a scathing book on antidepressant addiction, and I'll include some stuff from his book in this email. Also, I'd recommend a book called: The Anti- Depressant Fact Book: What Your Doctor Won't Tell You About Prozac, Zoloft, Paxil, Celexa, and Luvox (Perseus Publishing; paperback, 2001). To tell the truth, I have no specific idea what the answer is to your problem. I only know that we allow much broader use of antidepressants in this country than they do in Europe, and that many of them are really addictive. Here's another book: Prozac Backlash: Overcoming the Dangers of Prozac, Zoloft, Paxil, and Other Antidepressants with Safe, Effective Alternatives by Joseph Glenmullen (Simon & Schuster; 2001) has a withdrawal chapter of 40 pages And here's another one: Let Them Eat Prozac; The Unhealthy Relationship Between the Pharmaceutical Industry and Depression (New York University Press, 2004) by David Healy M.D., a well-reviewed history of the how the drug industry manipulates regulators, physicians and public opinion Here is a quote from my friend's book (he's a medical doctor): ''Many authorities believe that, just as with cocaine addiction, newborn infants suffer through withdrawal when the mother was using SSRIs such as Paxil, or when she was breast feeding while using Paxil. '' Since his book has not yet been published, I emailed him asking about this and if I could mention his book. Here is his response: ''There are numerous reports of newborn infants shaking in withdrawal tremors because their mothers were taking antidepressants. Similarly there are reports of infants suffering from antidepressants transmitted through their mothers' milk. In the UK they are much more aware of this problem. There is a massive cover-up in America. For example, Paxil's warning label in America spoke of only 0.2% withdrawal problems but the same drug label in the UK spoke of 25% withdrawal problems. The same system is making is difficult for me to publish an expose. Agents do not want to touch such a book, even though I say NOTHING that is not already in the public record. I am so upset at what is being done to Americans that I say you can quote anything I wrote, even this. I have enclosed an article that appeared on the Canadian Bloomsberg wire service about what antidepressants may do to newborns. Breast feeding infants are also similarly at risk.'' Good luck to you. cat

Canada Says Anti-Depressants May Harm Newborns, Post Reports Aug. 10 (Bloomberg) -- The Canadian government warned that popular anti-depressants taken by pregnant women can cause side effects in their newborns such as breathing problems, seizures and constant crying, the National Post reported. Some of the babies whose mothers took the medicines developed problems that required prolonged hospitalization, breathing support and tube feeding, the Toronto-based newspaper reported. Health Canada also said symptoms include muscle rigidity and jitteriness. The government's advisory cited drugs such as Eli Lilly & Co.'s Prozac, Pfizer Inc.'s Zoloft, Wyeth- Ayerst International's Effexor, Forest Laboratories Inc.'s Celexa, Solvay SA's Luvox, Akzo Nobel NV's Remeron and GlaxoSmithKline Plc's Wellbutrin and Zyban. The manufacturers are being asked to revise product monographs to reflect the concerns about the medicines, the Post said. Government officials and some experts said pregnant women shouldn't hastily reject the medicines because untreated depression may be more dangerous than some of the pills' possible side effects, the newspaper reported.

When this issue came up for me, about 2.5 years ago, a pediatrician that I trust said that Zoloft was the antidepressant most studied with regard to safety during breastfeeding. My brief web searches on medline, etc. confirmed this. I had been on other antidepressants before my son was born and off them completely during pregnancy. I took a small dose of Zoloft for about 1.5 years while breastfeeding. It helped me, and my son has shown no ill effects.

As someone who has long struggled with depression, I will add that antidepressants do take some patience to use. Finding the right dosage of the right drug (if you have a choice--which you may not while bfing) takes time. If this is your first time dealing with antidepressants, it really helps to work with a clinician who is both experienced in prescribing antidepressants AND who really listens to YOUR experience of the medication. Such people are not easy to find. Best wishes! kira

There is an excellent book available called,''Medications and Mother's Milk'' by Dr. Thomas Hale. I am a LLL Leader and have read passages out of the book for mothers wanting to know more about the meds they are taking. While LLL Leaders can not give medical advice we can give you info from this and other books. Please feel free to email me offline or call the LLL hotline. Melissa

Anti-anxiety meds and breastfeeding

June 2004

After being diagnosed with post-partum anxiety and depression I am considering medication (such as SSRI's). I have a on and off 10 year history of depression and anxiety (which has become progressively worse over the years) however I have yet to try medication. Up to this point I have experimented w/ numerous ''alternative'' drug-free approaches and frankly nothing seems to really work and I am tired of being a shadow of my former easy going, adventurous, happy self. Of couse now that I am finally willing to try meds, I am breastfeeding and weaning at this point (my baby is 2.5 months old) is not an option for me. I am interested in other women's experience with anxiety/ depression meds while breastfeeding. Did they work? What did you take? How much? For how long? anon

A little Internet research on this topic may be all the reassurance you need about the medical implications of SSRI's and breastfeeding. Your doctor can choose from among SSRIs to minimize any potential effect on your baby. If you are depressed or anxious, the decision to start an anti-depressant may seem very difficult to make -- I would encourage you to take your doctor's advice on this (not mine or anyone else on the network) and see how you feel in two months. You may find that the decision to continue or stop is more easily made once you get out of the fog. This is one of the trickiest parts of your life -- due to hormones, exhaustion and the miracle that is a baby (not all causes of stress are bad -- but all stress is hard on your body and soul!). Once your baby is sleeping well, you may find that diet and exercise and having someone to take over for you on occasion is an alternative to meds, or simply that the situation stabilizes and you feel great. In the meantime, your baby deserves you at your very best. If you have a history of depression, there's no better time than right now to stop it. You don't have to suffer to be a good mom. I have told friends that mild depression is like twilight falling at the end of a bright day -- sometimes you don't know how dark its gotten, until you think to turn on a light. Take care of you both. One who chose Prozac, past tense.

I have taken anti-depressants for about 6 years. I was taking wellbutrin when I told my psychiatrist that I was planning on breastfeeding. She immediately suggested switching to Zoloft, which has undergone more testing with regards to breastfeeding. She used to be a pediatrician, which made me feel more secure in her recommendation. My own research also confirmed that Zoloft is considered quite safe for use while breastfeeding. I take 75 mg. a day--50 in the morning and 25 at night. I take them right after breastfeeding, which supposedly decreases the amount transferred to baby. Almost everything that I've read indicates that any risks posed to the infant are outweighed by the benefits of breast milk, but certainly some would disagree. As someone who suffered from depression throughout childhood and early adulthood before trying meds--and who responded immediately and profoundly to them--I wish you a similar experience. The best thing for your baby is a happy, healthy Mom. Good luck. Happy New Mom

Good news. According to an article in the Mar/Apr 2002 issue of Mothering magazine (available at local libraries), some antidepressants, including some SSRIs, are OK for nursing because very little medication passes through the breast milk. Others, however, are considered unsafe. Of course, you'll need to discuss the risks and benefits of any specific medication with your (and your child's) doctors. Anon.

I also suffered severe post-partum depression that was mostly marked by intense anxiety. It was awful. And I am here to tell you that I would not have made it t! hrough without Zoloft. Zoloft is the one to take when you're pregnant or nursing and there are years of data to back that up. Ask your OB about it or your therapist (or both). Really, there is no need to suffer. You deserve to enjoy this period of your life and you deserve to be able to be fully present for yourself, your baby and your partner (if you have one). I feel like Zoloft gave me my relationships back. It made me feel like myself again. it wasn't a false feeling--that is, I didn't feel happy about things that were vexing--I just felt like I could cope, like I could see what was worth worrying about and what wasn't adn I was equipped to address the issues. You don't mention if you're sleeping. Sleep deprivation alone is enough to plunge you into anxiety/depression. It's CRITICAL that you sleep. Easier said than done with a small one, but if you can express milk or even use formula for one feeding (or two) a night and have your partner do them so you can get 5 or more hours of sleep it will help your mental state. I did that, but I also had to take a sleeping pill when on Zoloft. It was ''activiting'' for me (it's not for everyone). So my husband took night duty with the baby which, I think, was good for all concerned--he was pulling his weight, I was getting a break and sleeping, I was a happy spouse, he had the foxhole middle of the night bonding with the baby. My baby is now over a year old and things are going wonderfully. Good luck. anonymous

I can't yet speak to the issue of being on an SSRI while breastfeeding, but I am taking Prozac while pregnant right now and plan to stay on it while I breastfeed my baby. The SSRI's have been around long enough now that they have been studied in pregnant and nursing moms, and the research indicates that they may be less harmful to your baby than untreated depression. Prozac is not the first choice during nursing--I believe that Zoloft and Paxil are preferred. However, since I am on Prozac already (a relatively low dose, 20 mg/day), my doctor recommended that I just stay on it. (I have an older child and suffered from debilitating postpartum depression after his birth, and subsequently when I tried going off Prozac to conceive this child.) Yes, you need to do your own research, talk to trusted medical professionals, and wei! gh the pros and cons for yourself, but don't be afraid to go on meds while breastfeeding! You may be amazed at how much better motherhood is when you are feeling more like the old self that you think you have lost. I commend you for seeking help--and you aren't alone! Anon

My best friend (who will recognize me from this response!) recently told me that I am the most relaxed she has seen me in the twenty years she has known me, even though I am working full time and have a six month old and two year old. She of course knows my secret--PAXIL!!!! The post-partum and nursing hormones aggravated my lifelong anxiety and depression to the point that I could not stand it any more. (Like you, I tried everything to avoid drugs.) After talking to my psychiatrist and pediatrician I decided to try Paxil, even though it is not my first choice drug, beca! use it is believed to be safe for nursing. (Weaning was not an option for me either.) Both doctors believed that the benefits for my kids of having a healthy mom outweighed any potential risks to the baby. I take 5 milligrams a day and my only regret is that I did not do this with baby #1! I am a better mom, wife, employee, everything with these 5 milligrams. I am having so much fun as a mom that I want a third already! Life is just delightful now that I am not consumed with anxiety and depression.

There are only a few drugs that they will let you take while you are nursing and those may not be the perfect drug for you. There can also be a lot of trial and error with taking meds so you have to be patient. For me, 2 milligrams can make the difference between happiness and being a zombie. I would recommend finding a doc you really trust. Good luck!!!! Life is good on Paxil

I had crushing post partum anxiety after the birth of my daughter and given my family history of depression/anxiety, decided to seek help after exercise and all my usual 'cure alls' failed. On the advice of my much trusted ob/gyn I met with Dr. C. Mallouh in SF who specializes in post-partem disorders. She proscribed lorazapan which is similar to atavan (not sure of the spelling) both anti-anxiety drugs, but my understanding is that less of the lorazapan goes into the breast milk, so it is preferred for breast feeding mothers. this is backed up in ''The Nursing Mother's Companion'' which has a chapter on breastfeeding and medications). I desperately needed help and taking the lorazapan saved me and seemed to have no effect whatsoever on my daughter. I took it for about 45 days at which point I weaned off because my baby needed surgery and I was too worried about h! er going under anesthesia with other drugs present even in small amounts from breastmilk (no one told me it would be a problem, I just didn't want to take the chance and wanted to continue breast feeding). Talking with Dr. Mallouh through this also helped. I would highly suggest seeing a specialist in post partem disorders and that counseling go along with any medication as I was first proscribed Prozac by my ob/gyn which didn't help. Everyone is different and Dr. Mallouh was able to better pinpoint the problem and suggest a solution that really worked for me (helped me feel like my old confident self again within a few days and that was almost 2 years ago with no relapse). It is horrible and scary to feel so afraid and uncertain particularly when you are caring for young children, but I promise you it doesn't have to be that way! Dr. Mallouh can be reached at 415.750.1713 if you'd like to set an appt with her or ask for a ! referral to a post partem specialist in your area. Anon

My advice to you, go away of medications as long as you can specially you have a child with you all time. These medications have alot of side effect where is hard to handle the child and his tantrum in the same time. Yoga may help a lot specially with hormonal changes. You can try Albany community center Yoga classes. Try to push the medications a while longer.

Have you tried medical marijuana? I know several moms who have used marijuana medicianlly and their children seem fine. In fact, they seem ahead of other children their age. Good luck with everything. I hope you get your old self back.

I am sorry that you are suffering with postpartum depression and anxiety. I am a psychotherapist who works a great deal with these issues. I think that for most women deciding whether or not to try psychotropic medications is a complicated decision and nursing brings in even more considerations. I imagine you will receive numerous responses to your posting which will provide a broad spectrum of experiences and responses to medication use. This can be both helpful and possibly confusing. Educating yourself is definitely an important aspect of feeling comfortable with whatever decision you make. And, I believe that weighing the possible impact of using medication against the impact of living with depression and anxiety is important to assess. Postpartum.net is a website from Postpartum Support International and has various articles, resources and an on-line forum for discussing postpartum stress issues. I'd also recommend the organization Depression After Delivery (depressionafterdelivery.com) for information and resources. And, if you decide to seek assessment re: medication, I strongly urge you to consult with a psychiatrist who is well versed in working with the issues of nursing moms and medication. I have spoken with numerous psychiatrists about this issue. Please feel free to contact me if you would like appropriate referrals. All my best, Lee

Effexor & Klonopin while nursing

April 2003

I have been struggling for months now with depression and anxiety, and have just been prescribed effexor (anti-depressant) and klonopin (anti-anxiety) for treatment. I am, however, still nursing my now 20-month old son and am wondering if there is anyone out there who has had experience with either medication or both. I would really appreciate some feedback in regards to your experience on your own well-being with the medication(s) as well as your child's, if you were also nursing while taking the medication(s). I am having some trouble making the decision to either take them or not, due to the fact that I'm still nursing. However, therapy alone has not helped to alleviate my outlook and mood, which is why my doctor has suggested medication. I appreciate any and all responses. Thank You!

I had to make a similar decision not so long ago and it was hard decision for me to make as well. It actually took me sevearal months to decide I really wanted the medication and feel reasonably assured it would be fine for my nursing son. I am taking Tegretol. I finally found a woman psychiatrist who I felt was well informed and sympathetic and with her advice I took the medicine and was glad I did. Undoubtably. being depressed and anxious contibutes to the difficulty in making the decision. After taking the drugs I was able to share the moment with my children, happier and more patient. anon

I can't speak to nursing but I have taken Klonopin and antidepressants (not Effexor).

Klonopin is a valium-family drug, the only one in this group that is considered appropriate for long-term use. It's mainly an anti-seizure drug; I was put on it for several years to control neuropathic pain. It will make you very sleepy -- it's also used as a sleeping pill -- and though you will acclimate to the sleepiness, it won't really go away. Like all valium drugs, it's potentially addictive, although less than most because there's no ''high.'' To go off it, you need to taper off over several weeks because of potential seizures, even if you've never had a seizure. All this makes it sound serious, maybe more serious than it may really be.

I'm curious why you would be prescibed Klonopin if you're depressed, because it can exacerbate depression, and there are antidepressants that also control anxiety.

I believe Effexor is an SSRI, which means it can have an effect on sex drive and functioning. I was put on Paxil, also an SSRI, for neuropathic pain and depression. The initial dose was pretty usual but way too high for me, and made me manic for a week before I crashed. At half that dose I was cheerful and had zero interest in (and no ability to focus during) sex while feeling vaguely aroused much of the time. There are some entertaining SSRI-side-effects websites telling stories about no sex drive coupled with spontaneous orgasm in inappropriate circumstances, such as in line at the bank, which (given my experience) sounds plausible. At this time I take about 1/4 the original prescribed Paxil dose plus an antiseizure drug for the neurological stuff.

Re depression: If you go on meds, please continue psychotherapy. Even if depression has a physical cause alone, drugs aren't enough to deal with it. It's also important to do active stress management, spend time with friends, *plan* for fun activities, and get enough exercise (while caring for your child!). A combo of aerobics and something meditative like yoga, tai-chi, chi-gung, or Kum Nye can make a huge dent in depression, and I find supports the effect of meds.

You say you have depression and anxiety: depression is a high-energy state where the energy (often anxious energy) is turned inward and eddies away erosively inside. Hence you can be fatigued and overwhelmed while not getting much done. Meditative practices can slow the internal hurricane and free some of the energies the hurricane is consuming. I know that depression makes it hard to take the needed self-care steps: please remind yourself that it's worth it -- and get your therapist to help you on this. The best place for the meditative practice is in a class, because it's hard to do meditative practices when depressed and anxious, and you may feel like you're failing because you won't feel at all as serene or focused as you may think you should. This is a common experience in meditation. A teacher can help you with this.

Please note that if you go on meds, you may have to try several before you find one that has the right effects (and minimal side effects) for you. And I'd advise starting at the lowest possible dose, which may be much lower than what the doctor recommends, and slowly increasing from there. If possible, start with one drug only. Hang in there -- I know this is tough. anonymous

Did anyone out there take antidepressants while breastfeeding?

Anyone out there on antidepressants while breastfeeding? I took prozac through my pregnancy but it's just not working anymore. I also keep reading it's not the drug of choice during breastfeeding. I stopped taking it and now 6 weeks later I'm losing my sanity, and my poor husband. I have anxiety, moodiness, head aches, and could cry on the spot. Help if you know anything.

I would like to know if anyone took antidepressants (SSRI) during pregnancy (or while breastfeeding). I am not even sure if I will get laughed out of the room if I ask a doctor. You can respond anonymously to the advice line. Thank you so much.

I took Paxil during my pregnancy (my son was born in May '98). I tried to quit, but I was just too depressed, so I cut down slightly -- from 50 mg to 40 mg a day. I had called the Teratogen Institute (or something) at UC San Diego to find out what they knew. They said that there were no human studies for Zoloft or Paxil (but I could participate in one), but the animal studies showed no abnormalities. Apparently the study of Prozac showed no abnormalities except that the babies were slightly jittery.

My pregnancy was normal except for some high blood pressure in the last month. My son was over 11 pounds, and his only health problems were related to his large size. He was not jittery -- on the contrary, he was difficult to rouse for feedings! I'm still breastfeeding and still taking 40 mg of Paxil because my doctor and I both think that the mother's positive mood and breastmilk outweigh the risks from the Paxil.

I was on an SSRI (Prozac) at the point that I became pregnant with my daughter. Within a few days of discovering my pregnancy, I quit taking the SSRI, cold-turkey (this is NOT recommended, but it seemed to work out OK for me). In the process of making that decision, I was told by several physicians (and my reading backed it up), that the SSRIs seem to be safe in pregnancy. I chose to quit anyway, because of the lack of data on long-term effects. But if you really NEED that SSRI, and are in danger of hurting yourself or the baby without it, then you should by all means TAKE it! I hope you are able to ask your physician about this--you need to be able to speak candidly about it, especially at this critical time in your (and your child's!) life.

This is in regard to taking antidepressants during pregnancy. My daughter was born on 06/11/99, I stopped taking my prozac as soon as I found out I was pregnant, which was the day I missed my period ( 4 weeks pregnant). I became really depressed and at about 10 weeks my Dr. checked with the neonatal specialists in the hospital and they both agreed the benefits outweighed the risks. So I resumed taking 20mg daily. My daughter was born perfect as far as we can all tell. In fact her dr. says she is advanced for her age (10 weeks). Of course I worry that some day they will find out it causes some ailment, and Im researching breastfeeding and antidepressants now, but, I would think being depressed would cause more harm to your fetus than the studies have found the drugs have.

There are many anti depressants that are compatible with breastfeeding. Two that I remember off hand are Zoloft and Paxil as well as Prozac which you already mentioned. Many drs. are not comfortable prescribing meds to breast feeding women because almost every manufacturer says that the medicine shouldn't be used while breastfeeding. That is because most of them have not done any testing and don't want to open themselves up to a lawsuit by saying it is safe. This goes for all types of medicines too!

There is a great book that you can buy called Medications and Mother's Milk By Thomas Hale. This book lists almost every medicine (and some herbs) out there and lets you know if the medication will get into your milk, how much, if it is safe, etc. It sells on Amazon for $25, but I have heard you can find it cheaper through other net sources. Good luck.

La Leche League will be your best friend. There is a wonderful woman by the name of Lyla in Oakland who listened to me, helped me and made me feel comfortable when I needed to be heard very badly. She has loads of information and doctors the she can refer you to. From what I understand, zoloft is preferred over prozac while breastfeeding (although I dont have any personal experience with it). I have never met her in person but her name is Lyla (sp?). Good luck to you, and remember that being depressed is NOTHING to be ashamed of and it is NOT as character flaw. It is a condition like any other medical condition. Best of luck.

I wanted to offer some resources to the woman inquiring about medication and breastfeeding and to all women who may be experiencing postpartum depression or anxiety which can develop up through 18 months.

Shoshanna Bennett 510-727-4610 specializes in Postpartum Emotions and is totally up to date on all medications and breastfeeding. She offers individual consultations as well as groups. We in the Bay Area are lucky to have her as a resource.

My understanding is that Paxil and Zoloft are increasingly being prescribed for breastfeeding mothers. They have not been around as long as the tricyclics for treating depression, but initial studies seem to show very small amounts in breastmilk and no evidence of buildup in baby's serum. (The levels of Paxil have been measured in a mother's breastmilk, and were found to be extremely low, about 0.34% of the maternal dose (J Clin Psy,1996.)

Two Books which women have found useful are:
This Isn't What I Expected, by Karen Kleiman and Valerie Raskin
I Wish Someone Had Told Me, by Nina Barrett

Organizations: Depression After Delivery (D.A.D.) 800-944-4PPD

Postpartum Support International (PSI) 805-967-7636

Postpartum Stress Center & offices of Karen Kleiman 610-525-7527

I think I can help with your problem of not feeling like the Prozac is helping. I had an internist subscribe prozac and give me the standard dosage. She had me check in after 3 months. Whereas recently, I have gone to a psychiatrist who monitors me weekly until we get the dosage correct. I was always worried about the stigma of going higher than 20 mg for prozac, but he explained to me everyone absorbs prozac differently and that you have to adjust for metabolism... Well, since my metabolism is extremely high from breastfeeding we had to significantly raise my dosage. So, my advice is to work closer with your doctor or find one that monitors you more closely. You probably only need to increase your dosage temporarily. Believe me it makes the world of difference!!

For the person who asked about Prozac and nursing: I asked a similar question a few years ago when I sure could have used some prozac. I had gone off for the pregnancy and nursing. There were no good answers out there, but Layla from the Oakland La Leche League was so very helpful and knowledgable that I would track her down again. She also referred me to a doctor out of the area that has done alot of research on this topic. When I contacted him (all I know is that he called himself Dr. Tom) he told me that zoloft was better than prozac if the baby is very young. My doctor thought it would be best NOT to use it while nursing. I decided to wait it out 13 months till weaning my baby to start. I dont know if I would do that again. I was adamant about nursing but looking back, the untreated depression nearly destroyed my marriage and made me a miserable (still very caring) mom. I hope there are better answers out there today than 2 years ago. Good luck.

Although I don't have personal experience, there is a big book called something like Medications in Breast Milk which is what lactation nurses refer to when a medicine for the mother is called for. In my experience, doctors don't have access to this book, they just look up the medication in their little pocket PDR guide and it will say not tested on nursing women or some such thing. Get in touch with a lactation nurse and they will look up the medication for you, and discuss it. There are other factors as well, like how much you nurse your baby, how much other food/milk/formula he or she eats, etc which sometimes make the difference in whether you should start a medication which is not absolutely manditory for your health. Good luck, keep nursing. Elizabeth

I feel I need to share my experience with post-partum depression. I had it bad in 1995 after the birth of my child. I also had post traumatic stress syndrome from the birth experience. It was very difficult and got life-threatening, long story. What helped my recovery at the time was nursing and counseling. I am alarmed at the number of mothers out there who are being told to wean their babies and go on medication. It breaks my heart. For me, breastfeeding was my medication. It soothed me and kept me bonded with my baby. I also went to a therapist to talk and I joined a new mom's support group. My depression continued for a couple of years and I eventually started therapy with Linea Larsen who also does EMDR therapy. This helped a lot and after awhile I was ready to get pregnant again. My second child is due in August. I know that there are different levels of depression, and medication is needed and helps many, but I would hope that mother's doctors would do more to preserve the nursing relationship first.

There is an outpatient clinic at Langley Porter at UCSF that specifically does referral work, evaluations and follow-ups for medications such as anti-depressants. I don't have the phone number but it is, I believe, run by Dr. Owen Wolkowitz. It happens he is a good friend of mine, and there is an article in HEALTH magazine April 2000 issue, largely about the psychopharmacology research he (and others) are doing on stress and depression. Peggy

Prozac is one of those antidepressants that's probably safe for breast-feeding mom's to use but it's not the best choice out there. Dr. Hale (author of Medication and Mothers Milk) recommends that Paxil or Zoloft be used instead *if they work for the mom* because they are safer. But if those others are not a choice, then Prozac is considered by most breast feeding-friendly doctors to be better than weaning. The key is careful monitoring of the baby for changes in behavior. (But heck, you should do that whenever you take any drug.)

Here is some information that was posted on another list I was on that was for breastfeeding/pumping moms. (The original author said it was Ok to pass it on.):

There is controversy over whether or not Prozac (Fluoxetine) is okay to take while bfing. Some doctors say Yes and some say No. According to Hale's, the AAP says Drugs whose effect on nursing infants is unknown but may be of concern.

The entry in Medication and Mothers Milk on how much Prozac gets into the milk is lengthy here is an attempt to paraphrase it: In one study, it seemed like infants were getting 5-9% of the maternal dose. However, in another case severe colic, fussiness and crying were reported in an infant whose mom was receiving 20 mg a day. Concentrations of fluoxetine & norfluoxetine where 340 ng/mL and 208 ng/mL respectively which is almost twice that of normal maternal range. It seems that the infant was getting about 2x what the infants in the other study were getting. When the mom discontinued the drug, the infant got better. Hale reports that he doesn't know if this situation is common but he's received 3 other reports where this happened.

Hale does list two possible alternatives, Sertraline (Zoloft) and Paroxetine (Paxil) which apparently have more trouble entering both the milk and the infant.

Also here is a good article on PPD and BFing and it has lots of links to other info on the subject: http://www.geocities.com/Heartland/Prairie/3490/ppd.html

And here are some other links about meds and PPD:
http://www.usnews.com/usnews/issue/000214/nycu/breastfeed.brf.htm http://www.parentsplace.com/expert/lactation/medications/qa/0,3459,6128,00.html http://www.parentsplace.com/expert/lactation/medications/qa/0,3459,8792,00.html
Here is some info about Paxil if you want to look at that as an alternative: As for Paxil, Dr. Hale considers it the best of that class of drug for bfing moms. The entry in Hale's says that it spreads throughout the body well with only 1% remaining in plasma and that in studies of bfing moms, the amount in the milk was .34% of the maternal dose (1/3 of what was in the bloodstream).

Here's an article from Pediatrics (the Journal of the AAP) which basically says that taking anti-depressants and bfing is compatible:

And here is some info about BuSpar if you are looking at that alternative: Hale's says: Buspirone (Trade name BuSpar) No data exists on excretion into human milk. It is secreted into animal milk, so would expect the same in human milk. BuSpar is mg for ms equivalent to diazepam (Valium) in it's anxiolytic properties, but does not produce significant sedation or addiction as the benzodiazepine family. It's metabolite is partially active, but has a brief half-lfe (4.8 hours) as well. Compared to the benzodiazepine family, this product would be a better choice for treatment of anxiety in bfing women. But without accurate breast milk levels, it is not known if the product is safe fro bfing women or the levels the infant would ingest daily. The rather brief half-life of this product and its metabolite would not likely lead to buildup in the infants plasma.

This is from the 7 Ed. of Hale's. There is a later edition and it conceivably could have more data on transfer to human milk that would give you something to go on. What I get out of this is that it's probably better than valium for a bfing mom. It's unclear if it would be better than Zoloft or Paxil. Valium, in case you are interested, is listed as drug whose effect on nursing infants is unknown but may be of concern.

In general, with *any* anti-depressant, even one generally considered safe while bfing, the infant should always be monitored in some way. This could be as simple as just watching for changes in behavior esp. excessive sleepiness or lethargy or as thorough as bringing the infant in for tests periodically. The details are something you would work out with your doctor.