prozac while nursing? paxil?

[JBug]

I finally made the extremely difficult (for me) decision to start on anti-depressants. My dr and I talked a lot and finally decided on Zoloft and I was feling pretty ok about it. Not great but ok. Then I found out that my insurance doesn't cover Zoloft. So my dr wants me to choose between prozac (her choice) or paxil. I need to hear about your experiences with these two drugs and nursing a small baby. I'm particularly worried about milk supply (mine isn't too great) and weight gain in baby while taking them. Any personal antecdotes are good. I'm a little freaked out by having to chose a different one than the one I felt ok about taking.

Thanks. (Cross-posted copiously, sorry)

[MsMoMpls]

Prozac has been ruled safe for nursing- paxil hasn't. Not that it isn't just as safe- just that it hasn't been around as long, less research. There is no evidence that any of the meds pass into breast milk. If you need them- take them. Your babe needs a healthy mom.

[georgia]

Dr. Thomas Hale, author of the annual "Medications and Mothers Milk" does say Zoloft is the SSRI of choice, followed by Paxil, which has been studied less, but according to Hale, appears that transfer amount to infants appears to be minimal. He says Prozac is "of concern" esp. for younger nurslings due to the possibility of fluoxetine build-up in the baby's bloodstream to toxic levels.

I agree w/msmopls, baby needs a healthy mama!

HTH!

Dr. Hale also wrote an article on Breastfeeding and Drugs (with a sidebar on depression) in Mothering #111, March '02.

[akulovany]

I take lexapro and have taken it for 10n months now. It has not affected m y milk supply at all and I feel great on it. Maybe ask your dr about it?

[Jish]

If cost is a factor, Prozac has a generic, I'm not sure if Paxil does now. I personally know people who have nursed on just about every ssri, as well as some of the older antidepressants (tricyclics). Not every antidepressant works the same for everyone, so the key is finding one that works for YOU. A professor at the U of Iowa has been doing a study on breastfeeding and antidepressants and I have several friends who were in the study on different meds. All of the ssri's are considered safe. While Hale may mention one as being better than another, a different source may mention that another one is preferred. It's hard to find one that is definitely better than another since each expert seems to have a different opinion.

The main thing to remember is that your goal should be to find one that works for you. The amount that gets into your milk is small, and the amount found in baby's blood is often nearly undetectible or is undetectible. Depression itself affects our children and the tiny amount of med that the baby might get shouldn't be a huge concern since helping the depression will be a big help for yourself, your child and family.

Good luck, and I hope you find one that works well for you.

[starlite]

Alright ... awesome advice has already been given to you so I'm going to give you a personal anecedote;

I take effexor - XR (category B2 - not even tested on animals yet) and I have tried the 'safe' stuff (Zoloft, cipramil, paxil etc) but it really just didn't work for me. I didn't ever want to be on medications ... I felt like this would be admitting failure as I tried so hard for so long to live with PTSD. I finally needed help when my ds was born and because of my anxiety/panis attacks I lost my milk. Ds is now 2.5 years old ... I only bf him for the first 4 months of his life and it was hell to loose that special bf'ing relationship both ds and I enjoyed. That was really tough ... but I still refused medicines and I was getting worse. Even my therapist said that medication was my only hope ... and I felt hopeless.

I started medication and it took a year to get it right and much trial and painful error. I had 3 miscarriages before medication and I really wanted to have another baby and enjoy the one I have ... so I got on the anti deppressant merry-go-round.

I have only been on effexor for 7 months and I am completely cured. I had so many reservations about medication but I truly feel like this tiny little pill once a day has given me my life back.

I just found out I am pregnant, 8-9 weeks along at the moment. As I have had 3 m/c's I'm considered a 'high risk' pregnancy. My GP has urged me to wean off effexor (what ... spirall back into hell???) because it is not known what effects this will have on my unborn child. Gee, that is a scary thing to be told! Oddly, my specialist recommends strongly that I continue to take my medication. He says there are most certainly risks - but he suspects my previous extensively autopsied m/c's were largely due to my depression/anxiety levels interferring with my hormones and diet. He said that although the risks were present with effexor and preg, that he had seen many babies born to mother's taking this particular medication and they seemed to be ok. He also said that if I am more calm and relaxed this dramatically increases my chances of a sucessful pregnancy outcome. I know I am eating wonderfully now, whereas before medication I would go 3-4 days a time without a morsel passing my lips and not even realise it. Big diff, eh?

Yes, there are risks and you can call me a negligent mother that cares more for herself than her unborn child ... but would you say it to my face the day I stopped taking medications and slit my wrists? I didn't think so. Take my word for it - in my case the benefits far out weigh the risks.

One other thing, if my unborn baby can survive 9 months inside the womb of a mother taking effexor - my born baby will continue to thrive on it's mother's breastmilk inspite of what the experts recommend. I don't see how damaging effexor contaminated breastmilk could be if my med. contaminated womb was tolerable. KWIM?

Anyway, enough about me. I have this stupid saying: "Do what you feel is the right thing to do, because it probably is!"

Warm wishes and good luck with the bf'ing - starlite

[TiredX2]

If cost is a factor, Prozac has a generic, I'm not sure if Paxil does now.

Paxil does have a generic, but I found it to not work as well as the brand name drug (for me).

I was on Paxil for about two years after the birth of DS and it definately made a big difference for my family. I have never heard of Prozac being recommended to a nursing mother (I know you can take it during pg)--- rather I've heard as above (Zoloft followed by Paxil).

Good luck!

Kay

[Ruthla]

My dr tried me first on Paxil but I had a horrible reaction to it (couldn't sleep at all, even when taking it first thing in the morning) and after about 2 days I felt so much worse than before. Anyway, my dr took me off Paxil in less than a week and then started me on Prozac (which I'd taken in the past with good results.)

Jack was about a year old when I started taking Prozac and I'm still taking it now.

[sbgrace]

I know your post was a while back...are you trying anything?

I did want to mention that my zoloft generic is pretty cheap. I would've selected paxil over prozac...but maybe considered other options instead.

[moondiapers]

I wouldn't take prozac if your baby is under a year old, it's been linked to FTT, making babies too sleepy to nurse.

[DecemberSun]

Originally Posted by starlite

I take effexor - XR
My GP has urged me to wean off effexor (what ... spirall back into hell???) because it is not known what effects this will have on my unborn child. Gee, that is a scary thing to be told!

Stay on it, starlite. I took 37.5 mg a day of Effexor throughout my entire pregnancy because my doctor said it was pretty safe. I was then switched to Zoloft after delivery so I could nurse.

Originally Posted by starlite

One other thing, if my unborn baby can survive 9 months inside the womb of a mother taking effexor - my born baby will continue to thrive on it's mother's breastmilk inspite of what the experts recommend. I don't see how damaging effexor contaminated breastmilk could be if my med. contaminated womb was tolerable. KWIM?

There IS a difference between chemicals that can pass through the placenta to the baby, and chemicals that can pass through your milk ducts. I don't know the specifics, but my aunt is a Nurse Practitioner who specializes in high-risk pregnancies, and she explained it to me. Somehow smaller molecules may pass through the barrier of the placenta and into the baby's blood stream, whereas larger molecules are kept out. Chemicals that are safe during pregnancy (because the placenta is protecting the baby) may not be safe to ingest during breatfeeding because the molecules are allowed to pass throught the milk ducts. So there is a difference between what is safe during pregnancy and what is safe when breastfeeding. Just FYI.


I agree with all the mamas here, generally SSRI's are safe for babies, especially when they keep mama happy, and stress levels low!

[Jish]

I wouldn't take prozac if your baby is under a year old, it's been linked to FTT, making babies too sleepy to nurse.

Remember that ppd itself can contribute to FTT. I have know many women who have taken prozac and nursed infants and none of them ever noticed that it made the baby sleepy. I'm not saying that it doesn't happen, but I don't think that it is the norm. We always have to balance the effects of the medicine with the effects of the depression itself.

[abbylotus]

Just wanted to add my .02.....I have been taking prozac (the generic) since my DD was 6mos (she's now 14mos) and we haven't had any problems with nursing.

I, also, was first given a Rx for zoloft but our insurance wouldn't pay for it and then took the prozac as a second choice.

Good luck!

Oh, I guess I should mention on what a positive difference the medication has made to my life....I can't imagine where I would be now if I hadn't gotten help.

[kimberlylibby]

I took prozac while nursing dd1 and during my pg with dd2 and the first 6 weeks pp.

I'm happily medfree right now, but it was a LIFESAVER at the time!!!