Resuming meds after birth-formula feeding

[IFinTN]

I normally take atenolol (for tachycardia) and Celexa (for anxiety/depression).  If I go back on these drugs after birth I won't be able to breastfeed. I'm thinking that it makes sense for me to go back on meds, which means I have to formula feed.


Is anyone else making this decision? It really sucks to have to choose between breastfeeding and feeling like crap or risking severe anxiety/depression issues post partum.  

[emilyanimals15]

I'm on prozac and a stimulant for depression and narcolepsy. I switched from celexa to the prozac and I also switched stimulants before TTC. I worked with a psychiatrist who specializes in perinatal mental health. We decided the risks of going off meds outweighed risks of staying on. Since baby will be getting a very very low dose from BF I have decided that I will BF and my doctors support me. The literature on both meds shows no evidence of birth defects or other problems in my case (which doesn't mean there is no risk). I can't speak for atenolol but it's worth a long conversation and looking at the literature. Or if you have decided meds = formula feeding, that's fine too. It's a cliche but you need to be take care of yourself to take care of your baby!

[IFinTN]

Jan 27, 2015 15:52:27 GMT -5 emilyanimals15 said:

I'm on prozac and a stimulant for depression and narcolepsy. I switched from celexa to the prozac and I also switched stimulants before TTC. I worked with a psychiatrist who specializes in perinatal mental health. We decided the risks of going off meds outweighed risks of staying on. Since baby will be getting a very very low dose from BF I have decided that I will BF and my doctors support me. The literature on both meds shows no evidence of birth defects or other problems in my case (which doesn't mean there is no risk). I can't speak for atenolol but it's worth a long conversation and looking at the literature. Or if you have decided meds = formula feeding, that's fine too. It's a cliche but you need to be take care of yourself to take care of your baby!

I had not thought of switching to Prozac. Celexa worked really well for me, did you notice any issues when you switched?

I think the atenolol is the bigger problem for me though...

[shmee]

I will be resuming Zoloft for anxiety and depression once this LO is born, and both my PCP and my OB are okay with me taking that and nursing. I agree that it's worth at least having a conversation about the risks vs benefits with your doctor, maybe there is something they could switch you to.

Either way, like emily said you have to take care of yourself before you can take care of your baby. Do not beat yourself up over it! You can't have a happy or healthy baby without a happy and healthy mama.

[emilyanimals15]

Prozac isn't as great as Celexa for my depression but there was just so much more known about it during pregnancy. And as for atenolol, I have no info and I can't find the GREAT page that my psychiatrist sent me to with links to literature on all types of meds and pregnancy/breastfeeding. If/when I find it I'll post it here.

[viola]

Good luck with a tricky decision. There are risks and benefits to every path you could choose. Take your time!

[corrys12]

Definitely find a specialist. My network of Dr's is huge, and when TTC I was refered to a Mental Health specialist facility that specifically treat women TTC, pregnant or post natal. They took me off of Welbutrin and Ativan but left me on Lexapro. They explained the risks to me and also communicated with my psychiatrist to ensure he was on board with the changes they suggested.

Therapy is pretty much required, at least to get me thru the medication changes and pregnancy. It has been challenging. Massive anxiety attack yesterday, to the point where DH thought I was going to pass out or need medical attentuin. And afterwards I didnt feel my LO moving. Which triggered even MORE anxiety. Like did I deprive him of oxygen during my episode?? Thank God today he is back to normal movement.

But it may be time to revisit the specialist.

Hopefully I can get thru the rest of this pregnancy without increasing my dosage. And I truly want to nurse, so anything I can do to make that happen in a healthy way I will do.

I feel your concern, but a pre/post natal psychiatry specialist is invaluable. Good luck.

[chertmm]

I have been thinking about this for the past week or so. I am really struggling without my ADD medication (adderal) and my sleep habits are terrible without my full dose of trazadone (I tried coming off of it completely, but I didn't sleep for 6 straight nights. I only take a quarter of what I used to take and I feel terrible for needing any at all. My OB insists that the benefit of sleep outweigh the risk of taking the medication). I am on a low dose of Prozac but I'm not sure if it is helping anything. I really want to BF, but I also want to feel more normal and productive. I was planning on talking to my OB and psychiatrist about this specific topic at my next appointments.

[IFinTN]

Jan 27, 2015 19:20:49 GMT -5 chertmm said:

I have been thinking about this for the past week or so. I am really struggling without my ADD medication (adderal) and my sleep habits are terrible without my full dose of trazadone (I tried coming off of it completely, but I didn't sleep for 6 straight nights. I only take a quarter of what I used to take and I feel terrible for needing any at all. My OB insists that the benefit of sleep outweigh the risk of taking the medication). I am on a low dose of Prozac but I'm not sure if it is helping anything. I really want to BF, but I also want to feel more normal and productive. I was planning on talking to my OB and psychiatrist about this specific topic at my next appointments.

You said it best...I want to feel normal and productive too. My tachycardia keeps my hr in the 130s even with the sad replacement meds they have me on. All it does is keep my palps at bay. I really miss my atenolol. I could probably live without the Celexa but I'd be much happier with it.

[samiamagirl]

I am actually going through the exact same debate right now. I'm discussing my options with my doctors and I've found out the med they'd put me back on are safe to take at a low dose while breastfeeding. It's a dialogue I'm keeping open with my doctors, I'm not interested on going back on med yet, but I'm at a high risk for PPD they are wanting me to have something in my system by the time I give birth. If you are able to find a psychiatrist who specializes in pregnancy and post-pregnancy mood disorders they'll probably be your best bet finding a happy balance. Good luck to you! I know exactly what a hard decision it is.

[Deleted]

Call and talk to the experts on drugs in lactation at Infant risk run by the Texas Tech school of medicine. Run by Dr Hale who is not only a pharmacist and researcher but also a pediatrician. Dr hale does research on drug effects on breastfeeding and collects data from research worldwide. He has a book called Medicarions and Mothers Milk.
806-352-2529.

You can also check the meds on Lactmed the database by the national centers for health for info about drugs on lactation

An advantage of calling infant risk is that they may be able to recommend an alternative drug. And they cover safety of drugs in pregnancy as well. Like there is a rating system for drugs in pregnancy there is also a rating system for drugs in breastfeeding a scale of L1-5.

Atenolol is rated L3 in breastfeeding which is moderately safe. But it's not considered ok in pregnancy. Propranolol is considered safer in breastfeeding L2 which is the safer drugs list. Metoprolol is another alternative which is rated L2 and considered safer in pregnancy as well.

I don't say this to recommend a drug or anything but to let you know that for every type of medicine there are safer drugs that might work for your medical problem if you talk to the right experts to get the info needed to know the options. Of course no drug is 100% safe even though a few like Tylenol Motrin and amoxicillin are considered L1= safest drugs list due to the huge amount of data.

So make some phone calls and do some research and ask the hard questions of your doctors and go see a specialist instead if taking anyone's word for your inability to breastfeed on a certain med or that there is no similar drug that would be safer. Good luck.

[jennadesigns]

I agree about working with your providers to find medication alternatives that may be safer in breastfeeding rather than ruling it out entirely, if it's something you really want to do.

I'm not familiar with your BP medication and breastfeeding but I will say that I think breastfeeding on Celexa is probably fine. I'm a big believer that mom's mental health is hugely important for the well-being of her baby. If you need to take an antidepressant to function to the best of your ability, there's nothing wrong with that and I wouldn't be concerned with the amount of Celexa the baby is getting through your breastmilk. If you're worried about that, consider switching to something like Prozac which has more research in breastfeeding. For what it's worth, I nursed my son on Prozac and Wellbutrin and I nursed my daughter while taking Lexapro. I will be nursing this one on Prozac and Wellbutrin.

This pregnancy I'm taking something called Saphris, which is an newer atypical antipsychotic, to treat my treatment resistant depression. I made the difficult decision to stay on the medication during pregnancy because my psychiatrist, OB and I agreed that my need for it outweighed the risks. It is not recommended that you breastfeed on it because they don't know much about it (It falls in the L3 category for breastfeeding). I was fully prepared to formula feed. Then I talked to my psychiatrist who said that she saw no reason not to breastfeed when baby has already been exposed to the medication in utero and at much higher amounts than she'd ever get nursing. She encouraged me to talk to my pediatrician about it, but said she supported me nursing. I used to take some other meds for depression/anxiety (ritalin and clonezepam) that I haven't been able to take while pregnant and I won't be able to resume after delivery if I want to breastfeed. I know I can live without those, so it's a sacrifice I'm willing to make.

The bottom line is you need to be healthy and happy to be the best mom you can be. If you're able to do that and breastfeed, that's wonderful. If you need to formula feed to take certain medication that's okay too. Talk to your doctors and get their input and suggestions.

[irishvodkagrl]

I'm actually having this same debate. I've noticed lately that my anxiety and depression have been getting a lot worse and I am worried about what that means moving forward and postpartum. I was on Celexa as well before I got pregnant, and I am planning on discussing with my doctor what I can take now and while breastfeeding.

Personally I think our mental health has just as much an effect on our babies as our physical health does, so we need to be champions for ourselves as well. There are so many resources and so much research around to support us making an informed decision, that I can't imagine anyone giving you crap for taking care of yourself.

[corrys12]

Just had an appointment with my psychiatrist today. At week 30 I am going to start weaning off the Lexapro so that by the time I deliver I will be taking nothing. That in and of itself is causing me some anxiety. But I am going to do yoga/breathing exercises and keep seeing my therapist to help me keep it together.

Dr said as soon as I deliver I can switch over to Zoloft which he said is ok while nursing.

I need to do some of my own research so that I feel comfortable that I am doing the right thing for baby. So many damn meds out there. But I too agee, baby needs a healthy mommy.

[willadiesel814]

I was on Zoloft pre-pregnancy and stopped when TTC. I just met with my dr today about starting to take it again. She said that she supports it because I need to be mentally healthy to take care of my two year old and this new baby when the time comes. While I am on the lowest dose I still worry.

However, she said that it was the safest medication to breastfeed with that they know of so far. So i guess that was reassuring. I breastfed my DS for 4 months, and would like to at least try again this time.

I am just going to do what i need to do, because having severe panic attacks and stress can't be any better for the baby then the trace amounts of Zoloft that will cross the placenta or breast milk.

[pintobean]

I normally take baclofen which is a muscle relaxer and prevents the spasticity in my legs. It also keeps it from feeling like my muscles are ripping when I walk. For some reason when I get preg it goes away and I can get off the meds. History has shown in the past after my miscarriages it returns within a week after I lose the babies.

My neurologist and I have already discussed what to do. I can not take baclofen and breastfeed. I'm suppose to schedule an appt for 2 weeks after delivery with my neurologist and she will get me medicated if needed, it usually comes back worse than before I got preg. I went ahead and filled a couple months worth of meds and I'll breastfeed until I can't. I really want to breastfeed BUT I have to be able to carry the baby so if that means formula then oh well, that's what I'll do.

[Deleted]

Jan 28, 2015 16:22:44 GMT -5 pintobean said:

I normally take baclofen which is a muscle relaxer and prevents the spasticity in my legs. It also keeps it from feeling like my muscles are ripping when I walk. For some reason when I get preg it goes away and I can get off the meds. History has shown in the past after my miscarriages it returns within a week after I lose the babies.

My neurologist and I have already discussed what to do. I can not take baclofen and breastfeed. I'm suppose to schedule an appt for 2 weeks after delivery with my neurologist and she will get me medicated if needed, it usually comes back worse than before I got preg. I went ahead and filled a couple months worth of meds and I'll breastfeed until I can't. I really want to breastfeed BUT I have to be able to carry the baby so if that means formula then oh well, that's what I'll do.

pintobean
Um be sure to call infant risk about this drug.
Baclofen is rated L2 for safety in breastfeeding which means it's on the safer drugs list.
The American academy of pediatrics states that it is a drug that is usually compatible with breastfeeding.

The bigger worry is that it may effect prolactin the breastfeeding hormone.

Dr hale states from the pharmacology of the drug (half life molecular weight protein binding volume of distribution) that even with limited studies it is unlikely to enter breastmilk in relevant quantities to effect baby.