I know the feeling of I know the feeling of struggling postpartum and being so scared to take medication. I was terrified of the effects it could have on my daughter's brain. I literally had anxiety about having anxiety.My main problem postpartum was I couldn't sleep. For the most part, my daughter slept fine. But it was the anxiety around sleep and whether or not she would wake up and stressing out and wondering if I should sleep train and thinking about what would happen to me if I NEVER SLEPT AGAIN. I'm not even joking when I say I had one week where I slept so little I thought I was going to end up in a psychiatric hospital.
I can't tell you how devastating it was to have your baby sleep soundly and to just lay awake all night stressing about whether or not she would wake up. I would cry all day because I loved my baby and I wanted to enjoy her but I couldn't because I was so exhausted and miserable.
I thought the sleep deprivation was the CAUSE of my anxiety and depression (I'm sure it did increase it) but never considered the opposite. That anxiety was the cause of me not being able to get to sleep.
The MOST devastating thought to me was that I would have to give up breastfeeding because I needed to sleep more. I had those thoughts and I knew I had to get help, because I absolutely adored breastfeeding.
I sought help from a perinatal mental health specialist (not covered by insurance) and she helped me formulate a plan to help prioritize sleep (while continuing to breastfeed) and then get supportive medication.
When it comes to choosing to go on ANY medications or even herbal remedies while breastfeeding, you need to consider benefit/risk.
There is always risks with any medications. There are also benefits. There are risks of you not going on medications. Are the risks of you not medicating bigger than the risks of medicating?
For me the answer was YES. If you're a "evidence and research" person, you can find lots of it on the safety of SSRIs like zoloft (what I take) and breastfeeding and not really any super concerning results.
There is also plenty of evidence on the effects of a mother having anxiety and depression on a baby. So you must weigh that against the risks of taking medication.
Most SSIRs are going to fall into the L2 category, which means "probably compatible" and there have been some studies without any evidence of adverse reactions in babies.
Benzodiazapines generally fall into the L3 which also means probably compatible but that there haven't been enough studies and you should only use the medication if the benefit outweighs the risk.
However, more research is coming out showing that the concentrations of these drugs in the milk are very low, and not a lot of adverse events occur. So it's really up to you and your doctor to determine whether these medications have benefits that outweigh the risks.
Lots of doctors will tell you that you absolutely cannot use these medications while breastfeeding, especially benzos mostly because of liability. If you look on the inserts of any drug you get from the pharmacy it always says "ask your doctor". That is the same info the doctor uses to determine whether or not he should tell you it's safe.
The lactation risk categories were developed by Dr. Thomas Hale and he has a lab which studies the concentrations of these substances in breast milk and the reactions that the babies have after. It's also worth noting that just because a certain substance is "transferred in breast milk" doesn't mean that your baby is going to be affected by it.
For me just knowing these medications were available was enough to relax me enough to sleep. And once I did finally get on a regular SSRI my mind quieted so I could get some sleep. I think it's important to not make breastfeeding or sleep itself a scapegoat as a "cause" of anxiety. Literally your mind can convince you of anything when you're deep in the throes of depression.
Empowered Breastfeeding Academy has a WHOLE MODULE on mental health! It's not just a "quit breastfeeding and get better" thing.
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