Pregnancy is a time of transition to becoming a mother. However it is also a time of great stress, turmoil and physical changes. This can precipitate psychiatric issues in the post-partum including postpartum depression. About 15% of women suffer postnatal depression, explains the best psychiatrist doctor in Chennai. Mothers are especially concerned about taking psychiatric medication when breastfeeding. This is totally understandable as medications do pass on to breast milk. Sometimes the medication can cause sleepiness in the infants, poor feeding and also because of the lesser capacity of the infant’s body to remove their medication quickly, it is likely to stay for longer. For new mothers insomnia treatment may be suggested to manage their new sleep cycle effectively.
That is why we do not advise medications unless it is absolutely required and in every case we assess the pros and cons involved. As breastfeeding is very important for the health of the baby and mother we take every possible step to ensure this is continued.
Antidepressants are largely found in studies to be safer in breastfeeding even though wide data is unavailable especially in long term follow ups. Commonly sertraline is safely used. Some studies have shown that fluoxetine is safer when prescribed between 20-40 mg. Some crying, colic, seizure-like activity has been reported.
Based on the available research, SSRI antidepressants are by and large safe but preference is towards sertraline.
However the older antidepressants known as Tricyclic antidepressants are best avoided due to higher risk of morbidity in overdose.
However if you have responded well to an older antidepressant, this has to be considered before switching the antidepressant.
One other safer antidepressant appears to be mirtazepine which can be used when night time sedation is required.
Sometimes the lady could have had bipolar disorder and on mood stabilizers. In case of lithium one has to be very cautious during breastfeeding and try and avoid. There are reports of low temperature, muscle tone becoming low, heart murmurs in infants. Since babies have immature kidney function, it can also cause dehydration rapidly.
Sodium valproate as a mood stabilizer could be a better option for breastfeeding mothers.
Carbamazepine and valproic acid are considered to be compatible with breastfeeding.
Benzodiazepines which are mainly used for sleep are best avoided .
As far as antipsychotics are concerned haloperidol, quetiapine and olanzapine are safer options
In conclusion we have to say most psychiatric medications cross into the breastmilk and can cause some effects even though the amount is way lesser than the safety limit. We can say the SSRIs especially sertraline is safe to use in breastfeeding. Moodstabilizers such as valproate and carbamazepine are safe to use. Mostly we avoid antipsychotics even though unavoidable quetiapine is safer to use. Online counseling for depression for the post-partum can be very helpful for the mother to handle this new phase of life with utmost confidence.
