07 July 2014

Breastfeeding and medication

Recently, I was talking to someone on Twitter about breastfeeding on (and after) antidepressants, and it hit me once again how big a role breastfeeding can play in a woman's decision whether or not to seek treatment for PPMD. For me, among other fears (such as my child being taken away from me), I was so far into the whole "Breast is best" mindset that, when the filter of PPMD was added to the mix, the idea of having to stop breastfeeding my baby was horrifying and extremely upsetting. Concern over having to stop nursing is one that I frequently hear/see brought up and it is totally understandable.

I have written a couple of blog posts in the past about why Breast is not always best (part 1 and part 2). That is not going to be my focus for this blog post. In this post, I'm just going to share what my personal experiences have been with breastfeeding and medication.

When I was admitted to the hospital with a diagnosis of Postpartum Depression, my baby was 3 months old and exclusively breastfed. I had held off on getting help but finally realized I was at a crisis point and went to the ER, where I was transferred and admitted to a psychiatric facility. Because I specifically didn't want to have to stop nursing my baby, we tried talk therapy for the first day or two, but I could hardly even open up about how I was feeling and we quickly realized that medication was necessary. They started me on Lexapro (I was soon switched to Celexa, a generic version, for Insurance reasons), Ativan, and Ambien, which are not considered "safe for breastfeeding", so I had to stop nursing. I was extremely upset, but accepted that if I wanted to get better, this was what needed to happen. My baby did fine switching over to formula and the only discomfort was on my end because I stopped nursing/pumping cold turkey (ow, ow, ow). 5 years down the road, my daughter is extremely smart and well-adjusted, and we continued to bond very nicely. Actually, I think we bonded better because I was on medication and was able to connect better (I definitely remember the connection better after starting medication).

That first admission, diagnosis, and start of medication were in July 2009. At the beginning of December 2009, I was diagnosed with hypothyroidism (my doctors had previously missed it, but that is a whole different story for another time). Pregnancy can cause hypothyroidism, and hypothyroidism can cause mental and emotional health problems. I was promptly started on a low dose of Levothyroxine, a thyroid hormone replacement medication, and started to see my symptoms lessening pretty immediately. My dosage only had to be adjusted once to get my TSH and T4 levels back to within normal limits, and that also kicked the rest of the PPMD symptoms. After 3 months of Levothyroxine, I was able to stop taking the Celexa, Ativan, and Ambien that I had been on since July, and all was well.

I have been on this same dosage of Levothyroxine for 5 1/2 years now and it has never needed adjusting. During my pregnancies, the OB monitors my thyroid levels with bloodwork once a trimester (more often if I start experiencing anything unexplained  that could be symptoms of my thyroid medication needing an adjustment), but so far everything has been fine.

In April 2011, I gave birth to our second baby. Even though we were sure the PPMD had been related to the hypothyroidism, at my midwife's recommendation, I started taking Zoloft at 38 weeks pregnant (read what the Mayo Clinic has to say about antidepressants during pregnancy) as a prophylactic measure, and weaned off of it at about 6 or 7 months postpartum. This was shortly before finding out that, much to my shock and attempts to prevent pregnancy, I had another bun in the oven.

That second baby nursed through Zoloft, Levothyroxine, and the first two trimesters of my third pregnancy. She finally weaned herself at about 13 months. I was about to force her to wean since she had started biting (yay for teething). Let me tell you, I thought getting a tooth to the boob was painful enough under normal circumstances but with pregnancy making the girls extra tender? Yeeeeeeeeah.... "ow" doesn't quite do it justice. But, at that point she was down to usually only nursing in the middle of the night and she weaned herself, so it all worked out happily for both of us.

I started on Zoloft again at about 35 weeks with my third pregnancy. The original plan was to wait until 38 weeks again but I had some symptoms of depression and anxiety that were due to situations that were going on totally unrelated to pregnancy and we thought it best to start the Zoloft a little early. Baby #3 was born in September 2012. I was able to come off the Zoloft at about 3 or 4 months postpartum that time, again with no issues. The only issues I had were when I started using the Nuva Ring and got super tired (plus some intrusive thoughts) but that all went away when I discontinued the Ring. Baby #3 was EBF until I started school fulltime when he was ~4.5 months old. At that point, I got a good double electric breast pump and started pumping so that he got exclusively breastmilk at daycare and EBF when he was with me. With my school schedule and everything else going on in life, the pumping got to be a bit too much and eventually I stopped pumping; he got formula at daycare and breastfed when I was around. He self-weaned at 9 months.

I've done a wide range of options for feeding my children. Exclusively breastfed, Formula fed, breastfed through pregnancy and a little past the first year mark, breastfed plus breastmilk in a bottle, and breastfed plus formula. I've nursed on different medications and off of them. There is no shame or failure in any of these methods that I chose to feed my children. At the end of the day, what matters the most isn't *how* I fed my babies but *that* I fed them.

My experiences and feelings may not be yours. I can not say what is right or wrong for you and your family, aside from telling you that taking care of yourself is absolutely right, and that anyone who looks down on or tries to shame you for how you feed your children is 100% wrong. What I can tell you is that you are a good mother no matter what method (or combination of methods) you choose to feed your baby[ies]. In order to take care of others, we have to take care of ourselves first and practice radical self respect. Self-care is vital to not only our own well-being but the well-being of our babies and our families.

Whatever your choice, make it and don't let anyone get you down. If they want to say that they don't approve or agree or whatever, you feel free to send them on over to me and I'll gladly have a friendly chat with them.


  1. Well said, Esther. Your statement that "it isn't HOW but THAT you feed them" is my favorite, I think. :)

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