The Tough Choice of Drug Treatment for Postpartum Depression


Many women on medication are told to stop breastfeeding their babies.(LWA-DANN TARDIFF/CORBIS)

Emerging research on postpartum depression is clear: Antidepressants such as Prozac work, and they're considered fairly safe, even for breast-feeding mothers. But half of all new mothers with postpartum depression are reluctant to take drugs because they fear medication transmitted through breast milk could harm their babies. Antidepressants are an effective treatment, but they leave breast-feeding women with a tough choice.

I was afraid of drugs
"Looking back, I probably should have gone on antidepressants the first time," says Amy Sky, 47, of Toronto, who had severe postpartum depression after giving birth to each of her two children. "I didn't know what they would do to the baby. I was completely afraid of drugs. I was afraid of aspirin."

Those who haven't given birth can't comprehend the pressure new moms feel to breast-feed. The "breast is best" campaign is promulgated by well-meaning public health advocates to educate women that breast milk is vital for their new baby's immunity, general health, and ability to bond.

This makes many women with postpartum depression feel they are in a no-win situation. "Women with postpartum depression avoid medication because they think they'll need to stop nursing. Nursing is not out of question at all for women taking SSRI antidepressants," says Ruta Nonacs, MD, associate director of the Center for Women's Health at Massachusetts General Hospital in Boston. "They're very safe, and the risk to the infant is very, very small," she says.

Antidepressants' effect on a fetus
Some antidepressants seem to be safer than others. A recent study of the most commonly used antidepressants during pregnancy, SSRIs, found no significant risk of major birth defects, although these results are far from definitive. The researchers did, however, report some instances of three specific birth defects: a defect of the brain, a type of abnormal skull development, and a gastrointestinal abnormality. How much antidepressant medication passes on to the baby during breast-feeding is not certain, but experts say the effect seems to be minimal.

That's not enough reassurance for many women. Half of women with postpartum depression want to avoid medication; for them, psychotherapy can help, suggests new research from the University of Toronto. Many psychiatrists err on the cautious side, too, because the use of antidepressants during pregnancy and breast-feeding is not well-studied and the stakes—an infant's health and well-being—are enormous.

Should you give up breast-feeding?
Sarah, 41, of New York City, suffered postpartum anxiety when her son was born. The psychiatrist she consulted prescribed Effexor, an SNRI (serotonin and norepinephrine reuptake inhibitor), and was aware of the scientific literature on the effects on antidepressants on nursing babies. "He advised me to give up breast-feeding if I took it because the drug could come through my breast milk. But breast-feeding my son seemed like the only thing I could do right as a mother," she says. Despite her husband's pleas that she to go on meds, Sarah endured the turmoil. After two months she decided to switch her son to formula and get relief from the drug.

Shoshana Bennett, PhD, a psychologist and founder and director of Postpartum Assistance for Mothers who has counseled more than 15,000 postpartum women, says the decision to take medication while nursing is one that women need to make in consultation with their doctors. She believes it's fine for women to stay on antidepressants, even as they nurse, although she's more a proponent of good nutrition and adequate sleep. "The most important thing is a happy, rested mom," she says. "This is the only job where breaks are not mandated by law."