mystic_eye_cda replied: "It would be better to use any of the SSRIs instead of prozac; such as zoloft, paxil, celexa, etc. (assuming you are using prozac for depression, otherwise there may be different drugs that are safer and used for whatever condition it is you do have) That being said a baby over 3 months can better metabolize drugs and around a year of age babies metabolize drugs as well or better/faster than adults, and a baby that is taking mixed feeds receives a smaller amount of breastmilk and therefore a smaller amount of the drug. The hormones involved in breastfeeding can also reduce the severity of depression and therefore weaning can make things worse The risks of the small amount of the drug the baby would receive do not outweigh the risks of formula for the baby and the risks of early weaning in mom. The risks of not treating are probably greater than the risks of treatment for both mom and baby. Using Antidepressants in Breastfeeding Mothers Highlights were that: * The effects of an untreated depressed mom on the infant are significant and hazardous; but the marginal effects of any medication usually are less hazardous than those effects. Treating a mom with postpartum depression (PPD) is much preferable to not treating, since a baby has a better outcome generally (as measured by Bayley scores, measuring interaction skills and speech and language development) when being cared for by a non-depressed parent. * PPD is significantly more dangerous compared to depression outside of postpartum; PPD patients are sometimes more likely to commit suicide, and need to be treated with due haste. Waiting to wean before starting medication is not a sound option. Also, weaning in order to treat is not a good choice due to the loss of the positive effects of breastfeeding. The rate of depression in the general population in an individual's lifetime is between 3% and 17%. However, in the postpartum population depression is about 15%, and is often more severe. For example, it moves to psychosis more frequently. * In all studies thus far, any negative effects of medication usually occur in the first 30-60 days postpartum, so breastfeeding beyond that and taking medication is usually fine. * Babies exposed in utero can suffer "discontinuation syndrome" (a.k.a. withdrawal effects) but sometimes this is misdiagnosed as a reaction to the continued medications in mom's milk, when really the milk transfer rate for many of the SSRIs is negligible. SSRI improvements over older drugs The SSRI family of antidepressants is significantly improved over older antidepressants as follows: * Not addictive * No associated buzz * Mild withdrawal or "discontinuation syndrome" in some patients * More rapid onset as compared to older tricyclics * Side effects generally wane over time * Reported 60%-70% response rate in patients. SSRI sequence of effects The sequence of effects for SSRIs is as follows: * Sleep and anxiety normalize within the 1st week * Motivation, interest, hopefulness and appetite return within 2nd and 3rd week * Mood and libido may improve after (libido may worsen) [...] Drug Hierarchy When choosing a medication SSRIs are generally the preferred choice for a breastfeeding mother. Side effects from SSRIs are most common in the first 3 months postpartum; so with an older baby, there is little concern. Hale's "choice hierarchy" is as follows: * Zoloft * Paxil * Celexa * Effexor * Prozac Concluding remarks Finally, Dr. Hale concluded his talk by saying that breastfeeding should be supported fully and not interrupted by mom's needs for medication; and that treatment of postpartum depression can be accomplished relatively safely in breastfeeding mothers. So, in his consideration, moms should continue breastfeeding and should get drug treatment as needed for depression. Issues Surrounding Psychotropic Drug Use and Breastfeeding Breastfeeding Benefits and Formula -Feeding Risks: Two Sides of the Same Coin Infants who are formula fed are at risk for more short- and long-term health problems than are their breastfed peers (Table 1). The American Academy of Pediatrics (AAP, 1997) recommends exclusive breastfeeding for approximately the first 6 months of life, and continued breastfeeding to at least 1 year or beyond. Formula-fed infants have more allergies and incidents of asthma and wheezing (Burr et al, 1993), more episodes of diarrhea (Clemens et al, 1999), more ear infections (Duffy, Faden, Wasielewski, Wolf, & Krystofik, 1997), and are more likely to be overweight or obese entering kindergarten (Armstrong & Reilly, 2001). Children who were not breastfed as infants are at increased risk for developing childhood cancers (Davis, 1998) and type 1 insulin-dependent diabetes (Virtanen et al., 1991). If a mother chooses (or is advised) to formula-feed, her health is at risk, too, both in the postpartum period and in the long term. Not breastfeeding increases the risk of postpartum bleeding, and women who do not breastfeed also have a greater incidence of obesity and osteoporosis later in life (Lawrence & Lawrence, 1999). Mothers who do not breastfeed significantly increase their risk of ovarian cancer (Lawrence & Lawrence), and a recent large -scale reanalysis of data from 47 different studies (including more than 500 ,0 000 women) found that mothers decreased their risk of breast cancer by 4.3% for every 12 months they breastfed (Collaborative Group, 2002). Mothers who do not breastfeed miss out on important mother -infant bonding and the empowerment many mothers find in being able to provide something positive and special for their babies (Lawrence & Lawrence). In other words, not only is "breast best," breast is normal. Breastfeeding and Psychotropic Drugs: General Considerations in the Healthy Full -Term Infant Many healthcare providers know little about the effects on the infant of drugs in breast milk, and fear possible harmful effects if a drug is known to have an unfavorable pregnancy category rating. However, whereas drugs present in maternal plasma during pregnancy can pass directly to the fetus through the placenta, the breast is much more selective. Most drugs do pass into breast milk, but almost all appear in only small amounts-less than 1% of the maternal dosage. Very few medications are actually contraindicated in breastfeeding women (Riordan & Auerbach, 1999). To better understand factors that affect drug transfer and concentration in breast milk, see Table 2. How can a clinician balance the clear health protections breastfeeding offers to both mother and baby with the risks that maternal medication might affect the nursing infant? Research about psychotropic medications in breast milk, or their effects on breastfed infants, are often limited to case reports or very small studies. Sometimes there are no data at all. Drug package inserts that are prepared by drug companies take an overly cautious approach and warn that any drug that has not been clinically proven safe should not be taken by a breastfeeding mother. It is possible this advice is based more on fear of litigation rather than objective evaluation of the benefits of breastfeeding and the risks of taking the drug while doing so (Mohrbacher & Stock, 2003) ?./temp/~eaXrsV:1 Summary of Use during Lactation: The average amount of drug in breastmilk is higher with fluoxetine than with most other SSRIs and the active metabolite, norfluoxetine, is detectable in the serum of most breastfed infants during the first 2 months postpartum and a few thereafter. Adverse effects such as colic, fussiness, and drowsiness have been reported in some breastfed infants. Decreased infant weight gain was found in one study, but not in others. No adverse effects on development have been found in a few infants followed for up to a year. If fluoxetine is required by the mother, it is not a reason to discontinue breastfeeding. However, other agents with lower excretion into breastmilk may be preferred, especially while nursing a newborn or preterm infant. The breastfed infant should be monitored for behavioral side effects such as colic, fussiness or sedation and for adequate weight gain. [...] Alternate Drugs to Consider: Nortriptyline, Paroxetine, Sertraline"