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Antidepressants are literal lifesavers for people all over the world. But for expecting mothers, they may be a cause for concern. Many FDA-approved medications — including many of the antidepressants available today — have been shown to pass from mother to infant via breast milk. Wondering if there’s a negative or worrisome relationship between antidepressants and breastfeeding is totally fair.
The answer to that question, however, is a little murky. Is it safe for you to keep taking your antidepressants, or should you consider finding a new one? Are there any medications out there safer for breastfeeding than others? What do you need to know about antidepressants and breastfeeding?
Whether you can continue taking your antidepressant is ultimately a question of circumstances individual to you and your mental health. To understand why, let’s take a look at the facts.
Let’s answer the biggest question on your mind right off the bat: are antidepressants dangerous to a breastfeeding baby? The answer is… we don’t know.
Antidepressants are relatively new medications and the shortest possible explanation for this whole topic is that we don’t really have long-term studies that have addressed whether or not there are long term dangers associated with breastfeeding from a mother who is on antidepressants.
For the most part, antidepressants have really only been around for a couple of generations. Most modern antidepressants like selective serotonin reuptake inhibitors, or SSRIs, have not been around for more than the time the average millennial has been around.
SSRIs and other psychotropic drugs in this category are really interesting medications — they help you balance the levels of serotonin and other neurotransmitters in your brain, and the result of that is that your brain has a more stable supply of those neurotransmitters.
When your brain has a more stable supply, it can better regulate the emotions those neurotransmitters control, like joy, pleasure, stress and sadness.
These medications can be used for the treatment of other psychiatric disorders, by the way, including panic disorder and anxiety disorders like generalized anxiety disorder, posttraumatic stress disorder, bipolar disorder and compulsive disorder.
For many women, mother or otherwise, these medications provide an invaluable lifeline — an ability to function, to cope or simply to live, and that benefit is often worth the many sacrifices in the form of side effects that these medications can sometimes bring.
When the risks present themselves to an infant too, however, parents often will take risks on their own health to protect that of their child when consuming their breast milk.
The risks of antidepressants when breastfeeding hypothetically include the same risks that are posed to a mother — namely, serotonin syndrome (a sort of antidepressant drug overdose) and withdrawal symptoms as the medications are discontinued.
The thing is, most studies have shown that the potential risk of side effects, overdose or high antidepressant levels and withdrawal are relatively small. While antidepressants can indeed be passed to a child through human milk, the exposure to antidepressants is relatively little, even when the mother is toward the upper limits of the medication herself.
Some reports have included infants with increased irritability, decreased feeding and sleep problems. Many of these were considered subtle differences and not necessarily linked to antidepressant use. The study did note that citalopram and fluoxetine seemed to have higher instances of adverse effects.
In general, a weight-adjusted dose of 10 percent of the maternal dose is what’s expected, and for the most part those low detectable levels pose no real danger of adverse outcomes to an infant.
At least, not in the short term.
Like we said, the long-term risks are unclear and at the moment there’s no substantive data to give us an accurate picture of what happens to those antidepressant-milked babies in their adult lives.
Meanwhile, many mental health experts point to the significant portion of the population of mothers who suffer from postpartum depression, and when you consider that percentile (up to 15%) alongside the portion of the population where depression was already part of their lives, it can be understandable why medical experts might be hesitant to recommend that depressed mothers stop taking their medications.
Should you stop taking medication while breastfeeding? No, at least not before talking to the health care provider who prescribed it to you or another healthcare professional.
There are many advantages to treating postpartum depression effectively, for the mother and their child alike, and those benefits might indeed outweigh the dangers of medication exposure for an infant.
Guidance these days suggests that a mother makes the final decision after speaking with a healthcare provider and understanding whether her depression necessitates pharmacotherapy for the treatment. That’s a big fancy way of saying to keep taking antidepressant medications if you need them.
What “need” means is ultimately up to you — toughing out a few months of mild depression to protect your baby from unknown risks may be worth some personal risk, but well-managed mental health in the most vulnerable months of your child’s life could be far more important to their growth and development.
Experts also note that if you’ve been using an antidepressant treatment during pregnancy, if the infant exposure is going to follow prenatal exposure, then in most cases it makes the most sense for the breastfeeding mother to simply continue pharmacologic treatment to manager her symptoms of depression, whether it’s severe depression or otherwise.
Postpartum psychiatric support is a growing field. A few decades from now, hopefully we’ll have some more data to give us a definitive answer, but for the time being it’s a judgment call that you should make for yourself — and that no one should shame you for, regardless of how you handle it.
Pregnant women, new mothers and anyone on psychotropic medications can benefit from chemistry, but if you’re in the postpartum period and dealing with maternal depression, and you’re trying to preserve the benefits of breastfeeding without taking any risks, there are other forms of antidepressant treatments to support you in the treatment of depression.
If you don’t want to take drugs during pregnancy or after, untreated depression is still a problem, that maternal illness can be addressed with therapy, lifestyle changes and other exercises.
Speaking of exercises, maintaining an active lifestyle is great for both your physical health and mental health. The same is true of maintaining a good diet, and setting realistic expectations about your mental health and your mothering plans. Part of that is being patient and forgiving of yourself in a time where you feel like there’s a lot at stake.
As for the big guns, psychiatric illness responds well to psychological therapy, and particularly cognitive behavioral therapy. If you’ve been in therapy during pregnancy, you should make time to maintain your schedule after giving birth as well.
And if antidepressant drug treatment is your first-line treatment during pregnancy, stick to it — don’t deviate from treatment with SSRIs to another form of medication while breastfeeding.
Antidepressants can create some potential risks for a newborn during the breastfeeding months of your life, but as serious as you should take those concerns, they might not ultimately be reason enough for a new mother to discontinue breastfeeding or discontinue use of antidepressants.
It may seem like a non-answer, but the reality is that without an understanding of your specific mental health condition and mental health needs, a recommendation could be inaccurate to what is ultimately best for you and your baby.
If you’re trying to navigate through the complexities of new motherhood and depression treatment simultaneously, your next step should be talking with a health care provider. A healthcare provider can better answer your questions and speak to your concerns than we can from the 30,000 foot view on this topic.
If you are ready to talk, we can help. Our online therapy options are available to you right now. In the meantime, check out our guides to some things you may be concerned about right now, including postpartum depression, depression treatment options, and the effects of stress.
Get the help you need to make the right decision today, for you and your infant.
Kristin Hall is a board-certified Family Nurse Practitioner with decades of experience in clinical practice and leadership.
She has an extensive background in Family Medicine as both a front-line healthcare provider and clinical leader through her work as a primary care provider, retail health clinician and as Principal Investigator with the NIH.
Certified through the American Nurses Credentialing Center, she brings her expertise in Family Medicine into your home by helping people improve their health and actively participate in their own healthcare.
Kristin is a St. Louis native and earned her master’s degree in Nursing from St. Louis University, and is also a member of the American Academy of Nurse Practitioners. You can find Kristin on LinkedIn for more information.
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