Are Antidepressants Dangerous in Breast Milk?

The presence of antidepressants in your breast milk probably isn’t dangerous. Untreated depression itself, however, is risky for both you and your baby.

Childbirth is an exhausting experience, followed by greater responsibilities caring for your new infant, often on little sleep.

It’s common to be emotional, filled with joy at one moment and sad and crying the next. “Baby blues” tend to fade after the first two weeks. But up to 20 percent of women experience postpartum depression, also called peripartum depression. They may see themselves primarily as anxious, rather than depressed. Either way, antidepressants can help. 

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If you were taking an antidepressant before you became pregnant, it’s standard practice to continue. About 25 to 30 percent of babies will show symptoms of antidepressants in their systems, which commonly include jitteriness, restlessness, and rapid breathing. But they resolve on their own.

About 20 years ago, the Food and Drug Administration suggested women taper off their medication two weeks before childbirth, but subsequent research showed that made no difference.

On the other hand, skipping your antidepressant isn’t risk-free for your baby. Having a depressed mother is stressful for newborns, and the effects of depression can last.

You might wonder how an antidepressant will affect your breast milk. “Most well-controlled studies are reassuring to date,” writes psychiatrist Jennifer Payne, MD, a professor at the University of Virginia Medical School in Charlottesville.

Let’s say you’re not taking an antidepressant and have been seeing a therapist, but you’ve been feeling steadily worse since childbirth.

• You may feel continually sad and too numb to enjoy your baby.
• You’re plagued by self-critical thoughts and feelings of failure and guilt.
• Sometimes you can’t make the simplest decision.
• After night-time feedings, you’re awake, full of worries that something awful will happen to you, your baby, or husband.
• You’re tired but can’t nap even when you have help with your baby.

Your first thought may be, “If I take antidepressants, I can’t breastfeed.” But that’s not true.

Although babies who are not breastfed can flourish, it’s a good idea to breastfeed if you can. The American Academy of Pediatrics and the World Health Organization recommend feeding babies breast milk exclusively for the first six months of life.

Breastfed infants, as they grow up, have lower rates of asthma, inflammatory bowel disease, and obesity. Breastfeeding can also reduce a mother’s risk of ovarian and breast cancer. 

The American Academy of Breastfeeding Medicine, the American College of Obstetrics and Gynecology, and the National Institute of Clinical Excellence published practical recommendations to guide doctors advising breastfeeding women about taking antidepressants.

Overall, the greatest risk is leaving your depression untreated. Some science, for example, indicates that the infants of mothers who have been depressed while breastfeeding for two months tend to gain less weight — but antidepressants don’t affect infant weight gain. 

If you’ve responded well in the past to an antidepressant, talk to your doctor about taking it again. If this is your first time, your doctor might start with prescribing sertraline (Zoloft), followed by paroxetine (Paxil) if Zoloft doesn’t succeed. Babies feeding on breastmilk from mothers taking those drugs seem to have no detectable signs of them in their blood.

Citalopram (Celexa) and escitalopram (Lexapro) are also considered safe, but they may make your baby mildly drowsy or irritable.

The studies on this question so far are small and short. Mothers could feel more confident if there were large studies following babies over many years.

You can see an overview of the evidence on specific antidepressants and breastfeeding in this chart. Some show up in an infant’s blood — although almost always without causing problems. Infant blood levels of fluoxetine (Prozac) may exceed the recommended 10 percent of maternal level. Venlafaxine (Effexor) may show up in an infant’s blood and cause drowsiness or agitation, but it is not considered dangerous.

Your doctor may suggest a benzodiazepine like clonazepam (Klonopin) because it could relieve symptoms quickly. Many women get more anxious when they first start an antidepressant. You might take a benzodiazepine at the same time, tapering off within two to three weeks after an antidepressant takes effect. That is especially helpful if you haven’t been able to sleep. A doula or night nurse could be invaluable during this transition.

The evidence supporting benzodiazepines during breastfeeding is not as strong as for antidepressants, Payne observes. Benzodiazepines do not tend to show up in a baby’s blood, but they are potentially addictive for the mother.

Electroconvulsive therapy and repetitive transcranial magnetic stimulation are also possibilities for severe depression that doesn’t respond to medication and therapy.

If you’re a parent, sibling, or friend of a mother who may be suicidal and doesn’t live with you, be sure you have access to her home. People who haven’t previously had a psychiatric diagnosis can attempt suicide. Drug abuse, legal problems, and big disruptions in relationships are all red flags.

If you see an immediate risk, stay with her if you can or take her to an emergency room. Reassure her that she’ll be admitted only if it’s truly necessary.

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