There are several posts on this site about mental health and anxiety for new moms because this is a subject that impacts so many of us.
But we haven’t discussed a part of mental health that is unfortunately more taboo in our society: Antidepressant use. Since I want to focus on more common antidepressants, I’ll mostly discuss Zoloft and breastfeeding.
I’ll be honest, I’m a little nervous to be talking about my own journey with antidepressant use for all the internet to see. But I know that when I was grappling with deciding whether to use an antidepressant, I would have liked to find an article like this. Plus, the stigma won’t go away if we don’t start to open up. So I’ll start with me.
And to provide you the most helpful information I can, I’ll also add in some of the science of how antidepressants work and how they affect breastfed babies. Heck, I’ll even talk about what it’s like to begin taking an antidepressant.
(Side note: I am not a medical doctor. I have a PhD in chemistry and expertise as an Exposure Scientist, which means I’ve studied a lot about people’s exposure to toxic chemicals, but that is not the same thing as a medical doctor and this post is not intended as medical advice.)
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Here goes my discussion of breastfeeding while on antidepressants…
Starting antidepressants as a breastfeeding mom
I’ve dealt with anxiety on and off for most of my adult life. After years of dealing with this issue, I finally started really getting the help I needed from therapy after my second daughter was born. I learned about taking chelated magnesium and using magnesium oil spray for anxiety.
And after a while, all this work began paying off! In fact, during my third pregnancy was probably the most relaxed I ever was.
But after my third child was born, there were some really intense life events that cropped up. And while what happened helped me to grow as both a person and a parent, things were pretty stressful.
And on top of that, I was still working through some postpartum anxiety (on top of the normal anxiety). After three children, I’ve come to realize that my mood swings peak at four or five months postpartum.
Even though the Momma Mantras helped, it was becoming clear that even they weren’t enough for the level of anxiety I was experiencing. I needed to go to the next level and I knew it.
So I considered taking an antidepressant. Because of my background in chemistry and Public Health, I knew that whatever I’m exposed to would end up, to some degree, in my breastmilk. I decided some research was in order.
Classes of antidepressants
There are several classes of antidepressants. Some are meant to be used in the very short-term, while others may be used for years or even a life time.
Benzodiazepines, or benzos, may be prescribed for those with extreme anxiety or insomnia. Two examples of benzos are valium and Xanax.
While these drugs do decrease anxiety, there’s a few serious problems with them. First, they can only be taken for two to four weeks, max. If benzos are taken longer than this, you can develop dependence on them and even become more anxious than you were in the first place! On top of that, it is possible to become high with benzos, so there is an increased risk of abuse with them.
And again, I was dealing with chronic anxiety. Benzodiazepines are meant more for a person going through one extremely stressful event (like a death in the family or some other major adjustment), not for daily use. So I knew those weren’t for me.
A better class of drugs for people dealing with daily, chronic anxiety is selective serotonin reuptake inhibitors (SSRIs). Even though SSRIs were developed to treat depression, they also work to treat some forms of anxiety.
Basically, serotonin is a chemical in your brain that is needed for people to have a sense of well-being. SSRIs work by preventing cells from removing serotonin from your brain. More serotonin; less anxiety (Full disclosure, this explanation of both serotonin and SSRIs is over-simplified, but the exact mechanism of SSRIs isn’t fully understood).
There’s a few SSRIs that are more likely to be prescribed to nursing women, Zoloft and Paxil. After doing a little more research and talking to my doctor, I decided Zoloft would be the first thing I would try.
Zoloft and breastfeeding (and other SSRIs)
My main concern with taking a drug that affects brain chemistry was the possibility of transferring it to my children. After all, I was tandem nursing at the time; what could the exposure do to my infant and toddler?
My friend had told me about a free app from the National Institutes of Health (NIH) called LactMed, that will give you info about levels of pretty much any medication in breastmilk, what effects have been found in infants from the drug, and even the effects of taking the drug during pregnancy! Seriously, if you are pregnant or breastfeeding, this is a great app to download. It’s free, and I don’t anything for sending you to the app. I just want people to know how to get solid info on drug transfer through breastmilk.
So I looked up Zoloft on the app. And because I’m an exposure science nerd (I have a PhD in chemistry/exposure science), I went back to the scientific journal articles to get the nitty-gritty on the research.
It turns out that yes, SSRIs, including Zoloft, transfer through breastmilk. Once you consider the concentration of the drug in milk, the amount of milk a nursling drinks in a day, and the size of the baby, it turns out that your baby takes in less than 1% of the dose that you get from your antidepressant.
With my background, I know that even small doses of drugs or other chemicals can have a big impact on babies, so this did concern me. At the same time, breastfeeding is really important to me personally, so weaning just to start a drug was a deal-breaker for me. I had to decide.
As I continued to do (even) more research, two other facts convinced me that even with this risk, it would be better for me and my kids for me to take Zoloft while breastfeeding.
1. I couldn’t find any information indicating long term effects on children caused by the combination of Zoloft and breastfeeding.
I looked, a lot. What I learned is that analysts can’t even detect the drug in the blood most infants who are exposed to Zoloft through breastmilk. This is partially due to the extremely low dose the babies receive, and partially because Zoloft is broken down quickly in the body.
On top of that, I couldn’t find any studies that talked about adverse effects in adults (or even older kids) of mothers who had breastfed them when they were babies. Maybe the studies just haven’t been done yet, or maybe all these people are fine. But the clincher for me was that:
2. We already know that growing up with an anxious or depressed mother can be damaging for young children.
We’ve already talked about how your anxiety can cause you to be irritable. And when you’re irritable, you’re less likely to be truly present with your kids and you’re more likely to be out-of-control with them. No wonder your anxiety can have a lasting impact on your kids!
My conclusions: There is no evidence that taking Zoloft while breastfeeding will damage my child, but there is definitely evidence that my poorly-regulated emotions can. So I decided to start the drug.
What’s it like to start an SSRI?
I was lucky when I started my medication. Since I teach college, I have a month or two of break from work, so I started then.
I’ll be honest: starting Zoloft is… not fun. For the first week or two my stomach was really upset, especially right after I took it (pro tip: Do NOT try to take an SSRI on an empty stomach. It was awful. Eat something first).
But that wasn’t the main problem: The main issue with starting an SSRI is that often it makes your anxiety worse while your body is adjusting to the new medication!
I really struggled for probably a month. In fact, during the worst week (week four for me I think?) I actually asked my husband to take a day off work to stay with me because I was afraid to be alone (the kids were with their grandparents, so they were fine).
About six weeks later, the issues started dropping off. One day, my husband and I decided to take the kids to tour a cave about 45 minutes away. We drove all the way there, and it turned out tours were sold out until the end of the day. So we got tickets, drove somewhere else to wait it out, just to find out that this place, too, had an insane line. So we basically just spent several hours driving around with the kids in the back. Nothing went according to plan.
Typically, this kind of thing would have driven me up the wall. But I was fine! In fact, my husband even commented, “Have you noticed how chill you are with all this?”
He was right! I was surprised. So as I settled in to the new medication, I found that I became much calmer and less reactive with my kids. I was still me, I was just a less stressed-out version of myself.
Possible risks of SSRIs
Of course, that’s not to say that there’s no issues at all with SSRIs. One that works for one person may not work for another, and there might be some adjustment with dosages until you find what works for you.
Sometimes SSRIs may cause insomnia. One of the most annoying side-effects I have found is that they can also cause restless leg syndrome at night, especially right before my cycle. Fortunately, I’ve found that taking chelated magnesium (NOT magnesium oxide) or spraying magnesium oil on myself mostly clears up that symptom.
SSRIs may also cause weight gain. Apparently this is more common with Paxil, but it’s also a possibility with Zoloft.
The biggest problem with SSRIs, I think, is that quitting them is at least as horrendous as starting them. You definitely don’t stop them cold turkey, and even a small step down in dosage causes (at least for me) extreme anxiety and mood swings. If you’re on SSRIs and ever decide to quit them, make sure you do it under the supervision of your doctor, for reals.
UPDATE: I tried to step down my dosage for Zoloft, taking about six weeks between each decrease. By the time I got to half my original dose, I was back to a constant undercurrent of edginess that simply wouldn’t go away. My doctor told me that I should step my dosage back up, and that while staying at the same dose for a long time should be effective, the drug can lose efficacy if you quit it and then try to start it again. While I am not up on the research for this particular topic, I’ll take his word for it. I went up to 3/4 of my original dose and am much steadier now.
Bottom line: Taking an antidepressant while breastfeeding is a very personal decision.
And it’s not one to take lightly. Talk to your doctor and get his/her input.
But there’s no shame in taking an antidepressant, so don’t let that be what keeps you from taking the next step if that is what you need to do.
Before I close, may I suggest finding other ways to get help before moving to the medical route? Studies have shown that combining therapy with antidepressant use has a much better success rate than antidepressants alone. I think a lot of this is because while antidepressants may make you feel better, therapy actually gives you tools to become less reactive and more responsive.
Fortunately, you can start learning tools to empower yourself to stay calm, even when you’re feeling those knots of anxiety in your stomach. Grab your copy of Momma Mantras now and learn phrases designed to help you find peace in the mental and emotional storm. I promise from personal experience that they are a game-changer.
Have you experienced taking an antidepressant while breastfeeding? Or maybe you’ve specifically chosen not to do so? Or maybe you’re still on the fence. Either way, I’d love to hear from you in the comments!