When faced with challenging times or navigating a PMAD diagnosis, many new parents wonder: are psychotropic drugs (like SSRIs) safe for breastfeeding?
Welcoming a new baby into the family is exciting, but it can also be challenging to parent a new child while navigating the ins and outs of breastfeeding. When a mental health disorder presents itself in the mix, it can feel completely overwhelming.
Editor’s Note: This article is for informational purposes only and is not a substitute for medical advice. Please consult your doctor or care provider with any specific questions regarding a PMAD diagnosis or medication concerns.
This article covers:
- Are psychotropic medications safe while breastfeeding?
- Breastfeeding and medications: what to consider
- Is medication always necessary?
- Assessing the risk: untreated illness vs. psychotropic medications
- Starting psychiatric medication while breastfeeding
- Why the number of exposures matter
- What to expect while taking psychotropic
- Resources for up-to-date drug information
1 in 5 moms experience a Perinatal Mood or Anxiety Disorder (PMAD) following childbirth, and deciding whether to consider medication can create additional anxiety.
Parents’ number one concern is keeping the baby safe–but it’s hard to know what that means when we’ve been bombarded with so much information regarding what’s okay and not okay during pregnancy and breastfeeding
Here, I will educate you on what you need to know regarding psychiatric medications and breastfeeding so you can make informed decisions about your and your baby’s health.
Are psychotropic medications safe while breastfeeding?
Yes, most psychotropic medications are safe.
There’s been so much hype in the media in past decades about whether certain medications are safe during pregnancy and breastfeeding.
Overly-sensationalized reports have claimed the risk of miscarriage, various congenital disabilities, and other medication-related issues.
But the reality is these risks were often no different than what they would be in the baseline population and for women not on medication.
Some studies have shown a slightly increased risk of preterm birth or low birth weight for babies born to mothers on psychiatric medications. But the average is five to seven days early and less than 97 grams (about 3.5 ounces) lower birth weight.
These risks aren’t a big deal when considering alternatives (like decreased maternal mental health outcomes). Also, the same – or increased – risk is posed by untreated illness.
It’s no wonder parents are hesitant and uncertain about how to proceed with medication while nursing their babies.
The below quote by Dr. Zachary Stowe well-illustrates the problems society has faced in concerns over the safety of medications while ignoring the risks of untreated PMADs.
“I have spent the last ten years of my career worrying about the impact of medications. I’ve been wrong. I should have been worrying more about the impact of illness.” — Dr. Zachary Stowe
What to consider when thinking about medication as a breastfeeding parent
The most common symptoms requiring treatment and potential prescriptions include anxiety, depression, and insomnia.
When meeting with a postpartum mom in my therapy practice, the two things I consider when deciding whether to recommend medication are symptom severity and duration.
All new parents are somewhat sleep-deprived and working to build confidence in parenting. They often experience some stress around the baby’s schedule, whether she’s still breathing at night and if they are doing things “right.”
Some emotional highs, lows, and frustration or impatience with your partner are expected.
But when you’re often struggling, unable to enjoy your baby, or can’t find restful moments free from sadness or worry, you may be facing a PMAD.
When symptoms are severe or persistent, medication may be warranted.
Are medications always necessary?
My first line of treatment is constantly educating clients on what PMADs are and teaching them some skills and tools to feel better. Many parents find relief in knowing they are not going crazy and that what they are experiencing is common.
Feeling less alone and reassured that they will get through it is sometimes all people need.
However, suppose symptoms are severe and don’t improve (or even worsen) after a few therapy sessions. In that case, I always advise a consultation with your OBGYN, primary care physician, or reproductive psychiatrist to obtain a prescription for medication.
Even more good news? Statistics have shown that 70% of moms respond well to the first medication they try.
Many breastfeeding moms are reluctant to start medication, and that’s understandable, but we’ll talk more about what’s safe below to help ease the concern.
Getting the prescription in hand doesn’t mean you have to fill it, but knowing it’s an option if you’re not improving can be a relief.
Assessing the risk: untreated illness vs. medications
Most psychotropic medications used to treat anxiety and depression are safe during breastfeeding.
When deciding whether to take medication while nursing, we always want to look at the risk of exposure to drugs versus the risk of exposure to untreated illness in both the mother and baby.
Struggling emotionally is not fun for moms, but many moms will unnecessarily suffer through it and avoid medication if they believe breast milk is contaminated by drugs possibly harmful to their babies.
Experts know, however, that untreated mental health issues pose a risk to moms and children. Risks that are far more undesirable than small exposures to medication through breastmilk.
Research has shown that infant exposure to the most commonly prescribed depression medication – Selective Serotonin Reuptake Inhibitors (SSRIs) – through breast milk is generally low to very low.
Research also shows that untreated maternal depression and anxiety can impact physical health as well as cognitive, social, academic, and emotional functioning in children.
Therefore, the decision not to take medication when warranted is not effective in protecting breastfed babies.
Next, let’s talk about what’s safe and where to begin regarding medication while breastfeeding.
Starting psychiatric medication while breastfeeding
SSRIs and breastfeeding
SSRIs are the first line of treatment for most PMADs, as they are the most commonly prescribed to treat anxiety and depression and have been the most well-studied.
There are several different types of SSRIs, but the common ones include:
Each medication has a unique side effect profile but ultimately works similarly.
Sertraline (Zoloft) tends to be the most commonly prescribed SSRI, as it’s been the most well-studied during the perinatal period; however, genetics determine a drug’s side effects and efficacy on an individual.
Let your doctor know if you or a family member has a history of responding well to a specific SSRI.
Note: SNRIs may be tried after two failed SSRI trials. Consult a prescriber well-versed in maternal mental health as needed.
Bipolar medications and breastfeeding
On the other hand, whether mood stabilizers used to treat bipolar (like Lithium) and antipsychotics for psychotic disorders (like Haldol, Zyprexa, Risperdal, and Seroquel) are safe during breastfeeding is more controversial.
Mothers with a history of bipolar disorder or those experiencing mania or psychosis should consult a reproductive psychiatrist.
Breastfeeding may be discouraged depending on the medication prescribed and dosage. Donor breast milk can be considered in these instances.
Consider the number of exposures when starting medication while breastfeeding
Regarding safety, we want to look at the number of things a baby is exposed to.
A mental health condition is an exposure. Medication is an exposure. We can’t completely avoid exposures, but ideally, we can minimize the number of exposures introduced.
When beginning medication, experts advise maximizing the dose of one medication first before switching to a new medication to limit the number of exposures to new medications.
I often work with moms already taking medication to treat depression or anxiety, but symptoms are significant, and the medication dosage isn’t high enough to be effective postpartum.
Commonly, these moms are reluctant to increase the dosage, fearing that the baby will be getting even more of the drug into their system. Increasing the dosage to eliminate symptoms of PMAD is generally advised and in everyone’s best interest.
Breastfeeding may be discouraged if multiple medications are necessary simultaneously, increasing the number of simultaneous exposures.
What to expect when taking medications postpartum (including common side effects)
Most psychotropic medications – excluding Benzodiazepines (i.e., Xanax, Ativan, Valium), explicitly prescribed for anxiety/panic attacks – should be taken daily rather than “as needed,” so don’t discontinue or skip doses, even if you are feeling much better.
Try taking them in the morning, with food, to decrease the risk of nausea. If you find them sedating, switch to taking them in the evening.
It can take up to four weeks for the medication to be fully effective, so be patient and ensure you’re on an adequate dose before trying something else.
I find that clients often wait for medication to “kick in,” expecting to feel a significant shift, but it’s only in looking back (“Wow, I forgot I ever felt that bad!”) that they realize the medication is working.
Consider asking friends and family members to weigh in on how you seem to be doing, as they may notice a change before you do.
Discuss your concerns about side effects (activating/sedating, weight fluctuations, etc.) with your prescriber.
The most common temporary side effects include:
- Mild nausea
- GI distress
- Feelings of sedation
- Increased anxiety or jitteriness
Most side effects are resolved within three to seven days.
How long will I have to take medication?
The postpartum period is delicate, with many changes, hormonal shifts, and healing. Taking medication does not mean you are signing up for a lifetime of being medicated, but giving them time to help fully is essential.
Consult with your prescriber, but I always advise clients to continue on most psychotropic medication for at least six months to a year from when they feel “normal again.”
This is because it takes approximately six to nine months for neurotransmitters in the brain to normalize. If you stop medication too soon, you risk a relapse.
When you’re ready to stop medication, work with your prescriber to taper off the pills slowly over a few weeks to a few months. Tapering off (versus quitting cold-turkey) can help alleviate side effects like headaches.
Final thoughts on psychotropic medications and breastfeeding
Medications work, and most are safe. The American Journal of Obstetrics and Gynecology says, “When a psychiatric condition necessitates pharmacotherapy, the benefits of such therapy far outweigh the minimal potential risks.”
Babies deserve to have healthy moms who can feel good and enjoy motherhood. You don’t have to suffer. Help is available, and by accepting help, you ultimately act in your baby’s best interest.
Author’s Note: I am not a prescribing physician: however, I have obtained advanced training and certification in maternal mental health through Postpartum Support International.
If you’re experiencing overwhelm or symptoms of a PMAD, check out my Empowered Motherhood course to help you learn and implement strategies on your wellness in parenting journey.
For help finding a reproductive psychiatrist in your area, visit the PSI Directory and enter “psychiatry” and your zip code into the search boxes.
Additional resources on medications and breastfeeding
For the most up-to-date information on medications and their effects on breastfeeding, check out the following resources:
- InfantRisk: call (806) 352-2519 or visit www.infantrisk.com
- MotherToBaby: call (866) 626-6847 or visit www.mothertobaby.org
- Massachusetts General Hospital Center for Women’s Mental Health
Other resources you might find helpful
Megan MacCutcheon helps overwhelmed moms find calm, confidence, and a sense of balance while raising young children. She is passionate about spreading awareness regarding the various and very common perinatal mood and anxiety disorders women can experience, and enjoys supporting moms through healing and finding fulfillment in their journeys. Check out her course at www.meganmaccutcheon.com/empoweredmotherhood