The Truth About Antidepressants and Breastfeeding: What You Need To Know
Most new parents feel some emotional upheaval after the birth of a child. For some, this emotional distress is more significant and lasts longer, eventually becoming a postpartum mood disorder such as postpartum depression (PPD) or anxiety.
About 10-20% of women are diagnosed with PPD in the first year after birth (1). Postpartum anxiety is less well-studied but known to be prevalent during pregnancy and postpartum. While research shows up to 10% of women are diagnosed with an anxiety disorder in the months after birth (2), actual numbers are likely higher. Anxiety and depression often are experienced together during the postpartum period (3).
If you are diagnosed with a postpartum mood disorder, your healthcare provider will likely first recommend a combination of medication and therapy. Some people are resistant to taking medication because they are concerned about how it may affect their baby. Let’s take a look at how mood disorders, medication, breastfeeding, and infant development are intertwined.
Taking care of yourself helps you take care of your baby
A birthing parent’s mental health has a direct impact on the first year of an infant’s life. The first few weeks and months after birth is a critical time for your baby’s development and PPD specifically can have a negative impact if left untreated (4). Children of chronically depressed parents can have social-emotional development challenges and be at risk for mood disorders, such as anxiety and depression, later in life (5).
Taking care of your mental health is one of the most loving things you can do for yourself and your baby. One way in which you can care for yourself includes taking or continuing medication for depression or anxiety while you are nursing. Some nursing parents may worry that antidepressant medications might harm their baby, but there are safe, accessible medication options. Be sure to consult your doctor first to determine the right medication for you.
Breastfeeding can positively impact your mental well-being
If you make the decision to breastfeed, did you know that it can actually help with depression? In addition to benefits such as reducing the chance of breast cancer for the nursing parent, or decreasing the risk of asthma and ear infections for the baby, breastfeeding can also have some positive impact on your mental well-being (7, 8). There is some evidence that women who breastfeed may be less likely to experience PPD (8).
And there is some evidence that people who don’t adequately treat their depression or anxiety may end up breastfeeding for a shorter period of time (8) and may not achieve their breastfeeding goals.
If you find that breastfeeding is hard (most moms and nursing parents do!), you are not alone. Getting help early can help you ensure you achieve your goals for breastfeeding your baby.
Depression can increase for moms and parents who stop breastfeeding earlier than they wanted (8) and working with a lactation consultant may help you breastfeed longer.
>> Read more: When does postpartum depression peak?
The truth about breastfeeding and antidepressants
Antidepressant medications are used for postpartum anxiety, postpartum depression, and postpartum rage. Many people get conflicting information about breastfeeding while taking an antidepressant.
It is important to know that overall most antidepressants are safe during breastfeeding. While the studies on medications in breastmilk can be limited, we know that the exposure to antidepressants is less in breast milk than they are in pregnancy (6) and many nursing parents find this reassuring.
If you are starting medication for the first time, your healthcare provider may specifically prescribe, sertraline (Zoloft), paroxetine (Paxil), and nortriptyline (Aventyl or Pamelor), which are currently thought to be the safest for breastfeeding (5).
The American Academy of Breastfeeding Medicine (6) recommends that if you are taking a mood medication that is working for you, like a selective serotonin reuptake inhibitor (Zoloft, Paxil), tricyclic antidepressant (Nortriptyline, Amitriptyline), or serotonin-norepinephrine uptake inhibitor (Cymbalta, Effexor) that you should continue that same medication during breastfeeding (6). If you are taking a different medication, it doesn’t mean you shouldn’t continue to take it however, it is important to talk to your healthcare provider to determine what medication is best for you and your baby.
>> Read more: Why Mirtazapine causes weight gain & how to lose weight on it
Other options for PPD and anxiety
There are other treatments that have also been shown to work well for depression and anxiety. For example, postpartum depression therapy, during which you discuss your feelings and find coping strategies, can be particularly beneficial.
Support groups are also helpful for some people and may work just as well as individual therapy (5). Whether you want to improve your depression and anxiety without medication or you are on medication already, incorporating postpartum depression and anxiety therapy or peer support can be a valuable part of your self-care plan.
There is no shame in taking medication for postpartum mood disorders
If you are planning to breastfeed or are breastfeeding already, and you are diagnosed with depression or anxiety, talk to your provider to see if medication is right for you and your care plan.
It’s important to find a specialized postpartum mood disorder provider, who can help you get accurate information that is specific to developing a personalized care plan.
References
- Gjerdingen DK, Yawn BP. Postpartum depression screening: Importance, methods, barriers, and recommendations for practice. J Am Board Fam Med2007;20:280–288ACOG. Screening for Perinatal Depression. Committee Option No. 757. Available https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression
- Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. The British Journal of Psychiatry. 2017 May;210(5):315-23.
- Wenzel A, Haugen EN, Jackson LC, Brendle JR. Anxiety symptoms and disorders at eight weeks postpartum. Journal of Anxiety Disorders. 2005 Jan;19(3):295–311.
- Earls MF, Committee on Psychosocial Aspects of Child and Family Health. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010 Nov 1;126(5):1032-9.
- Fitelson E, Kim S, Baker AS, Leight K. Treatment of postpartum depression: clinical, psychological and pharmacological options. International journal of women’s health. 2011;3:1.
- Sriraman NK, Melvin K, Meltzer-Brody S, Academy of Breastfeeding Medicine. ABM clinical protocol# 18: use of antidepressants in breastfeeding mothers. Breastfeeding Medicine. 2015 Jul 1;10(6):290-9. Available from: https://www.liebertpub.com/doi/full/10.1089/bfm.2015.29002
- ACOG. Breastfeeding Challenges. Committee Opinion No. 820. Available from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/02/breastfeeding-challenges
- Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. Journal of affective disorders. 2015 Jan 15;171:142-54.
Most new parents feel some emotional upheaval after the birth of a child. For some, this emotional distress is more significant and lasts longer, eventually becoming a postpartum mood disorder such as postpartum depression (PPD) or anxiety.
About 10-20% of women are diagnosed with PPD in the first year after birth (1). Postpartum anxiety is less well-studied but known to be prevalent during pregnancy and postpartum. While research shows up to 10% of women are diagnosed with an anxiety disorder in the months after birth (2), actual numbers are likely higher. Anxiety and depression often are experienced together during the postpartum period (3).
If you are diagnosed with a postpartum mood disorder, your healthcare provider will likely first recommend a combination of medication and therapy. Some people are resistant to taking medication because they are concerned about how it may affect their baby. Let’s take a look at how mood disorders, medication, breastfeeding, and infant development are intertwined.
Taking care of yourself helps you take care of your baby
A birthing parent’s mental health has a direct impact on the first year of an infant’s life. The first few weeks and months after birth is a critical time for your baby’s development and PPD specifically can have a negative impact if left untreated (4). Children of chronically depressed parents can have social-emotional development challenges and be at risk for mood disorders, such as anxiety and depression, later in life (5).
Taking care of your mental health is one of the most loving things you can do for yourself and your baby. One way in which you can care for yourself includes taking or continuing medication for depression or anxiety while you are nursing. Some nursing parents may worry that antidepressant medications might harm their baby, but there are safe, accessible medication options. Be sure to consult your doctor first to determine the right medication for you.
Breastfeeding can positively impact your mental well-being
If you make the decision to breastfeed, did you know that it can actually help with depression? In addition to benefits such as reducing the chance of breast cancer for the nursing parent, or decreasing the risk of asthma and ear infections for the baby, breastfeeding can also have some positive impact on your mental well-being (7, 8). There is some evidence that women who breastfeed may be less likely to experience PPD (8).
And there is some evidence that people who don’t adequately treat their depression or anxiety may end up breastfeeding for a shorter period of time (8) and may not achieve their breastfeeding goals.
If you find that breastfeeding is hard (most moms and nursing parents do!), you are not alone. Getting help early can help you ensure you achieve your goals for breastfeeding your baby.
Depression can increase for moms and parents who stop breastfeeding earlier than they wanted (8) and working with a lactation consultant may help you breastfeed longer.
>> Read more: When does postpartum depression peak?
The truth about breastfeeding and antidepressants
Antidepressant medications are used for postpartum anxiety, postpartum depression, and postpartum rage. Many people get conflicting information about breastfeeding while taking an antidepressant.
It is important to know that overall most antidepressants are safe during breastfeeding. While the studies on medications in breastmilk can be limited, we know that the exposure to antidepressants is less in breast milk than they are in pregnancy (6) and many nursing parents find this reassuring.
If you are starting medication for the first time, your healthcare provider may specifically prescribe, sertraline (Zoloft), paroxetine (Paxil), and nortriptyline (Aventyl or Pamelor), which are currently thought to be the safest for breastfeeding (5).
The American Academy of Breastfeeding Medicine (6) recommends that if you are taking a mood medication that is working for you, like a selective serotonin reuptake inhibitor (Zoloft, Paxil), tricyclic antidepressant (Nortriptyline, Amitriptyline), or serotonin-norepinephrine uptake inhibitor (Cymbalta, Effexor) that you should continue that same medication during breastfeeding (6). If you are taking a different medication, it doesn’t mean you shouldn’t continue to take it however, it is important to talk to your healthcare provider to determine what medication is best for you and your baby.
>> Read more: Why Mirtazapine causes weight gain & how to lose weight on it
Other options for PPD and anxiety
There are other treatments that have also been shown to work well for depression and anxiety. For example, postpartum depression therapy, during which you discuss your feelings and find coping strategies, can be particularly beneficial.
Support groups are also helpful for some people and may work just as well as individual therapy (5). Whether you want to improve your depression and anxiety without medication or you are on medication already, incorporating postpartum depression and anxiety therapy or peer support can be a valuable part of your self-care plan.
There is no shame in taking medication for postpartum mood disorders
If you are planning to breastfeed or are breastfeeding already, and you are diagnosed with depression or anxiety, talk to your provider to see if medication is right for you and your care plan.
It’s important to find a specialized postpartum mood disorder provider, who can help you get accurate information that is specific to developing a personalized care plan.
References
- Gjerdingen DK, Yawn BP. Postpartum depression screening: Importance, methods, barriers, and recommendations for practice. J Am Board Fam Med2007;20:280–288ACOG. Screening for Perinatal Depression. Committee Option No. 757. Available https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression
- Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. The British Journal of Psychiatry. 2017 May;210(5):315-23.
- Wenzel A, Haugen EN, Jackson LC, Brendle JR. Anxiety symptoms and disorders at eight weeks postpartum. Journal of Anxiety Disorders. 2005 Jan;19(3):295–311.
- Earls MF, Committee on Psychosocial Aspects of Child and Family Health. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010 Nov 1;126(5):1032-9.
- Fitelson E, Kim S, Baker AS, Leight K. Treatment of postpartum depression: clinical, psychological and pharmacological options. International journal of women’s health. 2011;3:1.
- Sriraman NK, Melvin K, Meltzer-Brody S, Academy of Breastfeeding Medicine. ABM clinical protocol# 18: use of antidepressants in breastfeeding mothers. Breastfeeding Medicine. 2015 Jul 1;10(6):290-9. Available from: https://www.liebertpub.com/doi/full/10.1089/bfm.2015.29002
- ACOG. Breastfeeding Challenges. Committee Opinion No. 820. Available from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/02/breastfeeding-challenges
- Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. Journal of affective disorders. 2015 Jan 15;171:142-54.