Anyone else have to make tough BF choices based on medications?

Karenin · February 2014

I'm still waiting for LO to arrive (she was due Jan 31) and i'm facing some tough breastfeeding decisions. I have been on Celexa for 5 years due to pretty sever anxiety and panic disorder, so going off of it was and is not an option for me. When DS was born I did a combination of pumping and FF b/c he never latched and my supply was low. At that time I was told that the benefits of BF outweighed the small risks of my medication being present in the milk. DS is now 2 1/s and normal and healthy. However, my Celexa now has a new warning on the label saying BF is not recommended- it did not used to say that. My psychiatrist specializes in women's health (so deal a lot with pregnancy, nursing, etc) and says that there are no new studies and the benefits still outweigh any risks. I'm waiting to hear back from my pediatrician.

I admit I'm struggling with this. I HATED pumping last time and only made it three months b/c I felt like a prisoner with my pump every three hours. However, if I can I'm hoping to BF this baby if she'll cooperate, and pump as much as I can if she won't, but when I remember the stress of pumping and add in this new concern that it's possible my medication is no longer recommended with BF, I get really stressed.

Anyone else dealt with these types of decisions?

worleygirl · February 2014

I made the decision (with my Dr) to stay on Zoloft during pregnancy and up the dose pp. I know it is considered the safest of the meds but there are still risks. I'm comfortable with it though.

monkeybutt61612 · February 2014

I made the decision not to breastfeed because of how much I despised pumping last time.

mrspharmd · February 2014

What dose are you on?

Here is what Brigg's says:
"A 1999 review of SSRI agents concluded that if there were compelling reasons to treat a mother for postpartum depression, a condition in which a rapid antidepressant effect is important, the benefits of therapy with SSRIs would most likely outweigh the risks (36). Nevertheless, nursing women receiving citalopram, in particular those taking doses >20 mg/day or concurrently with other sedative agents, should be warned of the potential for toxicity in their infants. Moreover, the long-term consequences of exposure to SSRI antidepressants in breast milk on the infant’s neurobehavior development are unknown (no such adverse effects have been reported to date, but additional research is needed). Avoiding nursing around the time of peak maternal concentrations (about 4 hours after a dose) may limit infant exposure. However, the long elimination half-lives of all SSRIs and their weakly basic properties, which are conducive to ion trapping in the relatively acidic milk, probably will lessen the effectiveness of this strategy. The American Academy of Pediatrics classifies other SSRIs as drugs whose effect on the nursing infant is unknown but may be of concern (see Fluoxetine, Fluvoxamine, Paroxetine, and Sertraline)."

Depending on your dose, and what time you nurse/pump, you should be fine. Especially since you took it during pregnancy and had no problems. The warning on the label I'm assuming is from the pharmacy, and those are very generic warnings that we are required to put on labels. No new study came out, the pharmacy may have just updated their system so the label changed.

MindyBadger1 · February 2014

I've taken Celexa (20mg) through pregnancy and EBFing with no concern. A happy/healthy mom = a happy/healthy baby to me. The only concern I would have is if I had to stop BFing cold turkey, just like people should wean off SSRIs to me, in my mind, it seems like it would be better if he weaned off the little bit he's getting too.

SoulTermination · February 2014

Lurker from A14 here. I've asked and asked my OB about my taking Celexa during pregnancy and breastfeeding, and she doesn't seem concerned in the least. I've also asked the nurses in her office who did things like my initial pregnancy bloodwork and my recent 28-week evaluation, and neither of them seemed bothered by it at all. I do agree with Mindy, that if we have to stop BFing cold turkey it might affect LO some (when I cut it off cold-turkey at one point my legs itched to the point where I made them bleed from scratching constantly), but I think if I have some frozen BM to keep alternating with whatever she's eating at that point, it'll hopefully taper down safely.

ChuggingWater · February 2014

My zoloft has the same warning. I discussed it at length with my obgyn, my PCP, and his Dr. All are comfortable with it, and it is the best thing for me.

Agree with MindyBadger about weaning due to SSRI.

JaneW2 · February 2014

I actually just stopped partly for this reason. I was on tricyclics (nortriptyline) before getting pregnant due to my fibromyalgia. I asked my doctor before pregnancy, he recommended that I quit right after the positive pregnancy test, which I did. Oddly enough, the fibro was pretty easy during pregnancy and didn't cause issues with my c-section, but a couple weeks after, it started acting up again.

My low-birth-weight baby never did manage to latch, but I did exclusive pumping. Still, I hated the pumping and the back pain was beginning to make it hard for me to be a mother, so at 4 weeks I decided to quit and go back on medicine. Baby's doing fine on formula. I wish I could have actually breastfed, but I think I made the right choice.

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Anyone else have to make tough BF choices based on medications?

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