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Anyone have any experience with this, or at least, educated opinions about it?
I have several friends who were prescribed Zoloft while nursing.
There still really isn't that much data, so it's very much a personal decision.  Some antidepressants are more fat soluble than others so they show up in your milk at different amounts, so someone considering this might want to ask a doctor about Zoloft because it's supposedly one of the lower ones.  Of the people I know who take these,  about half decided to stop nursing and the other half kept on.   None of these women remained on the medication for more than a year postpartum, while some of the ones who were nursing continued to do that after coming off the medication.  
I've heard of being prescribed Zoloft while nursing but just thinking about it sounds stressful. ("what if it hurts the baby?" kinda stuff.)

I guess I'm just wondering if the benefits outweigh the possible risks (whatever they might be.)
I think a friend of mine has Dr. Hale's Medications and Mothers Milk--  I'll try to get some more definite information for you.
(05-24-2009, 05:37 PM)Paloma Wrote: [ -> ]I've heard of being prescribed Zoloft while nursing but just thinking about it sounds stressful. ("what if it hurts the baby?" kinda stuff.)

I guess I'm just wondering if the benefits outweigh the possible risks (whatever they might be.)

Paloma, one of the biggest risks is the mom getting so depressed that it affects her ability to take care of the baby as well as other children - not to mention the mom herself.

I'm not talking about postpartum psychosis, just postpartum depression.

"just",   :P

If it's a dose that will help the stressful mom, and won't hurt the baby, I'd say it's a good thing for all involved..... and the sooner the better, so that the depression doesn't overwhelm the mom and she gets some relief.
(05-24-2009, 06:18 PM)ErinIsNice Wrote: [ -> ]I think a friend of mine has Dr. Hale's Medications and Mothers Milk--  I'll try to get some more definite information for you.

You don't have to wait, much or all of Dr. Hale's info is on kellymom.com

You folks know about kellymom.com right?

Me and the wife look up stuff on there all the time.

Go there, on the top left there's a "Is this safe when breastfeeding" link, go there, and things are broken down by category. They pull their data from multiple places, not just Hale's, good stuff!

From: http://www.kellymom.com/health/meds/anti...10-02.html

Here's the highlights:

Zoloft is the "best drug choice so far". It has a low, low transfer rate to breastmilk (17-173 ug/liter) in mothers taking up to 150 mg/day. In one excellent study of 11 mother/infant pairs, the zoloft was undetectable in 7 of the 11 breastfeeding infants' serum and minimal in the other infants. In two other studies of one and three mother/infant pairs respectively, zoloft was undetectable in the plasma of all 4 infants. A theoretical concern with Zoloft is that some babies may not gain weight as rapidly or as well when breastfed by moms on Zoloft; so weight gain should be monitored and dosage tweaked as necessary.

Drug Hierarchy

When choosing a medication SSRIs are generally the preferred choice for a breastfeeding mother. Side effects from SSRIs are most common in the first 3 months postpartum; so with an older baby, there is little concern. Hale's "choice hierarchy" is as follows:

    * Zoloft
    * Paxil
    * Celexa
    * Effexor
    * Prozac

His conclusion:
Finally, Dr. Hale concluded his talk by saying that breastfeeding should be supported fully and not interrupted by mom's needs for medication; and that treatment of postpartum depression can be accomplished relatively safely in breastfeeding mothers. So, in his consideration, moms should continue breastfeeding and should get drug treatment as needed for depression.

Some additional points (emphasis added is mine)
    *  The effects of an untreated depressed mom on the infant are significant and hazardous; but the marginal effects of any medication usually are less hazardous than those effects. Treating a mom with postpartum depression (PPD) is much preferable to not treating, since a baby has a better outcome generally (as measured by Bayley scores, measuring interaction skills and speech and language development) when being cared for by a non-depressed parent.
    * PPD is significantly more dangerous compared to depression outside of postpartum; PPD patients are sometimes more likely to commit suicide, and need to be treated with due haste. Waiting to wean before starting medication is not a sound option. Also, weaning in order to treat is not a good choice due to the loss of the positive effects of breastfeeding. The rate of depression in the general population in an individual's lifetime is between 3% and 17%. However, in the postpartum population depression is about 15%, and is often more severe. For example, it moves to psychosis more frequently.
    * In all studies thus far, any negative effects of medication usually occur in the first 30-60 days postpartum, so breastfeeding beyond that and taking medication is usually fine.
    * Babies exposed in utero can suffer "discontinuation syndrome" (a.k.a. withdrawal effects) but sometimes this is misdiagnosed as a reaction to the continued medications in mom's milk, when really the milk transfer rate for many of the SSRIs is negligible.

The SSRI family of antidepressants is significantly improved over older antidepressants as follows:

    * Not addictive
    * No associated buzz
    * Mild withdrawal or "discontinuation syndrome" in some patients
    * More rapid onset as compared to older tricyclics
    * Side effects generally wane over time
    * Reported 60%-70% response rate in patients.


Lastly, I recommend the AAP recommended meds they have as well (antidepressants aren't on there, but I point you to this for other meds generally)
http://www.kellymom.com/health/meds/aap-...-meds.html

Look for low pregnancy risk categories (A or B) if pregnant, and low lactation risk meds (L1, L2) if nursing.

edited to add Kellymom AAP med link
opps, wrong kind of nursing!!
(05-25-2009, 04:53 AM)Scipio_a Wrote: [ -> ]opps, wrong kind of nursing!!

:laughing: 

- Lisa
I can give you the heirarchy of anti-depressants and breastfeeding from Hale if you want, I just don't have it handy right now.
Zoloft is number 1 but it doesn't work for everyone and is often useless against anxiety which can be a major issue in PPD.
I will PM with some more personal information
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