What postpartum depression medications can you take while breastfeeding?

Many breastfeeding women who suffer from postpartum depression fear that taking medication will harm their baby through their breast milk. This misconception often leads them to suffer in silence, avoiding discussions about their depression with healthcare professionals.

However, the truth is quite the opposite. Women experiencing postpartum depression can and should seek help while breastfeeding without putting their infants at risk.

What are the safe solutions?

Today, there are safe solutions available that won't harm your baby. In this article, we'll guide you through the right treatment options, dispel myths, and explore the connection between postpartum depression and breastfeeding.

Postpartum depression: Definition

First, let's define postpartum depression. Approximately 10-15% of women will experience depression before or after giving birth, and symptoms can vary from woman to woman. These symptoms include difficulty concentrating, persistent fatigue, changes in eating habits, loss of interest in once-enjoyed activities, self-neglect, sleep disturbances, feelings of guilt, and anxiety.

If you've been experiencing these symptoms for at least two weeks, it's likely more than just mild depression; you may be dealing with postpartum depression. Seeking help is crucial. You can confide in a trusted friend or family member or consult a healthcare professional, such as a nurse or family doctor.

Postpartum Depression While Breastfeeding

But what happens when postpartum depression strikes while you're breastfeeding?

It's important to recognize that depression can affect both the initiation and continuation of breastfeeding, and breastfeeding difficulties can lead to depression.

Nevertheless, breastfeeding can be an empowering experience that strengthens the bond between a mother and her baby, thanks in part to the release of oxytocin, the "love hormone," during breastfeeding. Oxytocin fosters pleasant feelings and aids in coping with the challenges of depression. For some women battling depression, breastfeeding becomes a lifeline amid feelings of guilt and shame related to their maternal role, thoughts, and emotions.

Given this complex situation, a crucial question arises: Should women with postpartum depression be encouraged to breastfeed, especially when they require antidepressant medication or encounter breastfeeding difficulties?

The resounding answer is yes.

Most mothers grappling with postpartum depression choose to continue breastfeeding even when they need medical treatment. Taking antidepressants, for instance, should not deter you from breastfeeding. Moreover, alternative options, such as individual or group psychological or psychotherapy treatment, can provide assistance for those who wish to avoid medication.

Safe Antidepressants for Breastfeeding

Certain antidepressants are considered safe during breastfeeding as they pass into breast milk slowly and have minimal impact on the baby's well-being or milk supply. Among them are the following:

1. Lustral - Sertraline: This antidepressant is deemed one of the safest options for breastfeeding mothers due to its low transfer into breast milk. It's often the recommended choice for nursing mothers starting antidepressant treatment.
2. Cipralex - Escitalopram: Known to be safe during pregnancy and with no increased risk of birth defects, Cipralex passes into breast milk at a low concentration, making it a suitable choice for breastfeeding mothers. It's important to monitor both the baby's well-being and the mother's condition while using this medication.
3. Paroxetine: Only a small portion of this medication reaches the baby through breast milk. Recent studies have shown negligible levels of paroxetine in breast milk, with no observable side effects in the baby.

Benefits Outweigh the Risks

It's crucial to remember that depression, sadness, and anxiety negatively affect milk production, maternal functioning, and the mother-infant relationship. When weighing the pros and cons, the benefits of treatment far outweigh the minimal risks associated with medication use during breastfeeding.

Untreated postpartum depression can result in numerous parenting difficulties, including reduced energy, difficulty focusing on the baby's needs, self-care challenges, and an increased risk of suicide. Long-term consequences may include delayed speech, issues with mother-child bonding, increased newborn crying and restlessness, childhood overweight, and difficulties adjusting to kindergarten or school, along with social challenges.

Every mother is, first and foremost, a woman who must prioritize her well-being to care for her newborn and family. Medication treatment is considered very safe during breastfeeding, so we urge every woman to listen to her body and mental state and consult with a healthcare professional who can provide the best guidance.

Authors: Dr. Benny Chayen, Gynecology Specialist at Meuhedet, and Yonat Ran, midwife and coordinator of Women's Health at the Nursing Department at Meuhedet.