Breastfeeding on Psychotropic Medication

24 Oct

Nearly four months ago, I wrote about meeting my goal of breastfeeding for six months.  Now, No2 is almost 10 months old and we’re still going strong.  In fact, we’ve moved past the awkward “I can’t be bothered to nurse when there are sights to see and sounds to hear and kitty ears to grab” and No2 actually wants to relax and nurse.  It’s a sure-fire cure for the 5pm cranks and is a lovely way to wake up in the morning.  She’s even mastered nursing discreetly in the ergo carrier, which has made getting No1 to ballet class and preschool field trips a bit less intimidating.  I’m truly enjoying it.

It’s not without its costs, though.  If I have even one cookie baked with any milk products, she cries all night with stomach cramps.  So I’ve been completely dairy-free for 6 months now.  She’s still nursing twice at night, I think mostly just for comfort.  While I’d love to sleep for more than 5 hours at a time, it’s actually working for us (or maybe it’s just so much better than it was that the bar is absurdly low).  And then there’s the impact on my mental illness.

Many medications are compatible with breastfeeding, but unfortunately the mood stabilizer I was on before getting pregnant with No2 is not one of them.  It was a great med for me – low side effects, extremely effective at a low/medium dose, and I really felt like myself.  It managed the anxiety and the PMDD and eliminated the roller coaster of hormone-induced emotions.  When I discovered I was pregnant, I (with my doctors) made the choice to switch to a medication that was safer and better-researched during pregnancy: an SSRI combined with an as-needed anti-anxiety medication.  I truly believe these medications have helped me to have a different postpartum experience with this baby, and contributed to my healing birth experience.  Still, I am not 100% myself.  The medication handles about 80% of the PPOCD and anxiety symptoms, and I (along with my husband) am left to cope with the remaining struggle.  It’s not ideal and it is a decision that weighs heavily on me as I continue to nurse.

The bottom line is that I’ve chosen to stay on this medication regimen to facilitate breastfeeding.  Here’s why:

1. Though I am not symptom-free, I am not experiencing the red-flag symptoms (rage, inability to sleep, intrusive thoughts) that would send me back to my doctors for re-evaluation.  I feel like myself.

2. I have no hard evidence that the mood stabilizer would be the magic bullet this time.  My situation, stresses, and life are so different now than they were before getting pregnant with No2.  At that time, I was sleeping 10 hours straight each night, working out 4 times a week, and had only one child, and was working only 3 hours a week. Given the same factors now, the SSRI may work just as well.

3. Breastfeeding contributes to my happiness and is a time of meditation and relaxation for me.  This wasn’t always true.  I fought tooth and nail to get to this point, but now that I’ve made it, I don’t want to give it up.  I also believe that breastfeeding is the best option for my daughter, who suffers from a milk-soy protein intolerance.  And while she would absolutely be fine on formula, I’m thrilled she’s getting all the health benefits of being breastfed.

4. Changing medications is a long and sometimes difficult process.  Weaning from my current SSRI and tapering up to an therapeutic dose of the mood stabilizer  would mean weeks of side effects and emotional symptoms.  I’m mostly stable these days and not exactly excited to sign up for that little adventure.

I’m not advocating that everyone limit their medications in order to breastfeed.  I did not nurse my first past a few months.  There were some medical reasons, but honestly, when I stopped nursing her, I felt a huge sense of relief.  Breastfeeding was an intense trigger for my PPA with No1 and I am still so glad I decided to formula-feed her.  It was the best decision for both of us.

While I wish everyone could enjoy the benefits of nursing, it’s a personal decision that each mom (with her doctors and family) must make for herself.  Hell, sometimes it’s not even a decision – may mothers cannot breastfeed.  Instead of adding to the “you must breastfeed to be a good mom” lies, I simply want to tell my story in the hopes that it will help new mothers understand all their options.  Because you do have options, and no matter what you choose, your physical and mental well-being need to factor in.

More information on breastfeeding, PPD, and medications can be found below.  And as always, this blog is a memoir of sorts and is not intended to replace the advice of your doctor.

Dr. Hale’s Keynote Address to LLL in 2002 on treating PPD in breastfeeding mothers

Katherine Stone writes about why expectations to breastfeed can weigh PPD sufferers down

Mass General’s Center for Women’s Mental Health on Breastfeeding and Medications

11 Responses to “Breastfeeding on Psychotropic Medication”

  1. Toni October 24, 2012 at 11:14 am #

    Thank you for some fresh perspective.I’m going on nursing 10 months but my PPD is getting the best of me and am probably going on Zoloft soon. I love our nursing relationship but need to feel a bit more balanced, too.

    • learnedhappiness October 24, 2012 at 1:51 pm #

      I’m so sorry to hear you’re struggling. You have to take care of yourself, mama. You don’t have to stop nursing to take medication or seek other treatments – but it you do stop nursing, that’s okay too.

  2. katstone1 October 24, 2012 at 12:27 pm #

    Great piece Susan. Each mom has to do what’s right for her and works for her family. I’m so glad this is working for you.

    • learnedhappiness October 24, 2012 at 1:52 pm #

      Thank you, Katherine. It was a hard decision for me to make, especially because my husband disagreed (and still disagrees) about the best course of action. But I’m glad I’ve advocated for myself.

  3. story3girl October 24, 2012 at 12:36 pm #

    So proud of you for writing this and for doing what’s best for you. And remember that these decisions aren’t final or forever: you have to make the best decision for you right now, and if anything changes you make another decision. Love you and support all your choices. Always.

    • learnedhappiness October 24, 2012 at 1:52 pm #

      I love that. You’re right – if it’s ever not working, I can always change what I’m doing. =)

  4. Kristin Novotny (@littlemamajama) October 24, 2012 at 11:19 pm #

    Thank you so much for this post, Susan. I’m grappling with making this decision and, although I have until May to decide, it’s been weighing heavily on my mind. My psychiatrist encourages me not to BF since any med secretes something into breastmilk, but then my OB says that there are certain meds they put BFing mothers on. BFing didn’t work out with C for numerous reasons, so I don’t know if it would even work with this baby if I tried. There’s so much to think about and figure out, and I’m so thankful to hear your story and to look into the links that you’ve provided.


    • learnedhappiness October 24, 2012 at 11:36 pm #

      Hi, Kristin. 🙂 I’ve noticed that the best doctor to ask about breastfeeding and medications is a specialist. My pcp didn’t know Advil can be taken while nursing, and my regular psych told me I had to wean the SSRI a week before giving birth (which is way old school and unsupported by recent research). I met with a perinatal psychiatrist who was able to give me research-based info and was supportive no matter what I decided to do.

      I’m glad I could help – holler if you need anything at all. And no matter what you decide to do, it will be exactly what your baby needs. 🙂


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