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I have depression. Can I still breastfeed?
Yes. Breastfeeding is still the best option for feeding your baby, even if you're taking antidepressant medication for your condition.
Breastfeeding is good for you and your baby. Breast milk gives your baby all the nutrition she needs to thrive for the first six months of her life and can prevent infections and sudden infant death syndrome (SIDS). Breastfeeding also helps you bond with your baby.
The flip side is that breastfeeding doesn't always go smoothly in the early days, and you may be at higher risk of postpartum depression (PPD) if you have a hard time breastfeeding.
If you're experiencing problems breastfeeding, don't suffer in silence. Talk to your healthcare provider so you can get the advice and support that you need.
Can I take antidepressants if I'm breastfeeding?
Although small amounts of antidepressant medication do pass through breast milk, many antidepressants are generally considered safe for your breastfeeding baby. The amount of drug that might reach your baby in your milk is very low (generally much lower than the amount that passes through the placenta during pregnancy).
Selective serotonin reuptake inhibitors (SSRIs) are considered the safest medication option for breastfeeding moms. More research has been done on these drugs than on other antidepressants, and only low levels of these drugs are found in breast milk. SSRIs include:
Other types of drugs used to treat depression are also considered safe. These include:
- Serotonin norepinephrine reuptake inhibitors (SNRIs), such as venlafaxine
- Tricyclic antidepressants (TCAs), with the exception of the drug doxepin
How can antidepressants affect my baby?
Some studies suggest that breastfed babies whose mothers take antidepressants might be a bit more irritable or have difficulties eating and sleeping. But it's worth noting that babies born to mothers with untreated depression also have some of these problems.
Call your provider if you're worried that changes in your baby's behavior or eating and sleeping habits might be caused by medications that you're taking. Usually this behavior doesn't last long, but your provider can reassure you and rule out other problems, such as a viral infection.
Don't alter your treatment plan or stop taking medication without talking to your provider first. Not taking medication for depression when you need it isn't good for you or your baby. Untreated depression can make it harder to care for and bond with your baby, which can have negative effects on your child's health and development in the future.
What medications aren't safe to use when breastfeeding?
In addition to the tricyclic antidepressant doxepin, benzodiazepines aren't considered safe to take while you're breastfeeding. Benzodiazepines are used to treat anxiety, a condition that's common in people with depression.
Experts are concerned that benzodiazepines may interfere with a baby's brain development. Babies exposed to benzodiazepines through breast milk also are known to be very sleepy and have withdrawal symptoms when the medication or breastfeeding stops.
If you can't safely stop using a benzodiazepine, it's best not to breastfeed.
Are there alternatives to taking medication while I'm breastfeeding?
If your depression is mild, other treatment options can sometimes be effective on their own. For example, talk therapies, such as cognitive behavioral therapy, are effective for managing depression. It can be difficult to attend regular appointments when you have a new baby, but sometimes just a few sessions can make a difference.
Taking things easy, eating well, talking to friends and family, and exercising can all help, too.
You may be tempted to try herbal remedies or complementary therapies as an alternative to antidepressants if you're breastfeeding, but these are often unregulated and may not be safe to take. For example, the herb St. John's wort can cause colic, drowsiness, and lethargy in babies, so it's not recommended when breastfeeding.
What can I do to make breastfeeding easier?
Depression can make it hard for you to get a good night's sleep, and breastfeeding will also disrupt your sleep – which could only make your depression worse.
Try to catch up on your sleep by napping whenever your baby sleeps. Or have a family member, friend, or babysitter take care of your baby for a few hours so you can sleep. Even if you can't sleep, just resting may be enough to make you feel better.
Putting your baby's crib right next to your bed can make nighttime feedings easier, but don't have your baby sleep in bed with you. Antidepressant medication could make you drowsy, which may put your baby at risk of suffocation or SIDS.
Your partner can settle your baby after you've finished feeding. Expressing milk also gives your partner the opportunity to feed your baby and you a well-earned break.
What are the alternatives to breastfeeding?
Don't feel guilty if you choose not to breastfeed, or blame yourself if breastfeeding doesn't work out. Your baby will still get the nourishment she needs from formula, and you can lavish just as much care and attention on your baby while you bottle-feed her.
You can still hold your baby skin to skin while you feed her, giving her lots of eye contact and talking softly to her to nurture your bond. Holding your baby this way also helps her feel safe and calm as she feels your warmth and is reassured by your familiar smell.
Visit the Society for Maternal-Fetal Medicine's website for more information and to find an MFM specialist near you.