Antidepressants Tied To Lactation Problems
20 CommentsBy Ed Silverman // January 27th, 2010 // 8:34 am
Women who take several widely used antidepressants may experience delayed lactation after giving birth and may need additional support to achieve breastfeeding goals, according to a study to be published in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism. The drugs in question are SSRIs, such as Glaxo’s Paxil, Pfizer’s Zoloft and Eli Lilly’s Prozac.
“The breasts are serotonin-regulated glands, meaning the breasts’ ability to secrete milk at the right time is closely related to the body’s production and regulation of the hormone serotonin,” the University of Cincinnati’s Nelson Horseman, a study co-author, says in a statement. The drugs “can affect mood, emotion and sleep they may also impact serotonin regulation in the breast, placing new mothers at greater risk of a delay in the establishment of a full milk supply.”
The study examined the effects of SSRI drugs on lactation using lab studies of human and animal cell lines and genetically modified mice. And an observational study evaluated the impact of SSRIs on the onset of milk production in 431 postpartum women. Median onset of lactation was 85.8 hours postpartum for the SSRI-treated mothers and 69.1 hours for mothers not treated with SSRIs. Delayed secretory activation is usually defined as occurring later than 72 hours postpartum.
This is the second time this month that a study has worrisome news for parents and would-be parents. Last week, a separate study in the American Journal of Obstetrics & Gynecology indicated that, among nearly 3,000 women who gave birth in Washington State, those who started taking SSRIs in the second or third trimester had a higher risk of preterm birth (see here).
photo courtesy of sarah.anne flickr creative commons
Lisa Van Syckel
One should also be concerned with the efects these medications have on the growing brain of a nursing infant, let alone the effects they would have on the body as a whole.
patrons99
Excellent point Lisa! Thanks!
harpy
I’m more than a little appalled that it’s taken scientists over 20 years to test whether an SSRI would have an effect on a “serotonin-regulated” gland. But, on the other hand, women being second-class citizens, I’m not surprised at all.
pharmavet
The well-known effects of psychotropic drugs on serotoninergic/dopaminergic regulation of prolactin secretion has been known from studies in animals that go back at least 25 years. This is nothing groundbreaking.
dclulu
Lisa: Studies have found zero or only trace amounts of Zoloft and Paxil get into breast milk. See, for example, http://ajp.psychiatryonline.org/cgi/content/full/161/6/1066
The concentrations of Prozac are higher. That’s at least part of why many doctors don’t prescribe it to breastfeeding mothers.
Laurie
“The concentrations of Prozac are higher. That’s at least part of why many doctors don’t prescribe it to breastfeeding mothers.”
No, OB’s are pulling mothers off paxil(due to the Class D Pregnancy warning) and putting them ON Prozac. Leaving the infant exposed and the mother in Paxil withdrawal.
Lisa Van Syckel
dc .. You are a real “lulu” thats for sure. Psychiatryonline.org are “Industry Apologists”, Please provide the Pharmalot Readers with unbiased information, And while your at it, how about identifying yourself.
Lisa Van Syckel
Pharmavet,.. It is grounbreaking news as far as dclul is concerned.
harpy
“Early research suggests a link between antidepressant use and breastfeeding difficulties in new moms.”
“But the study is the first to explore the impact of antidepressant use on lactation in humans.”
source
If what you say is true, pharmavet, then I’m even more disgusted by the fact that no one cared enough to look into this earlier. but, wtf, right? there’s always formula.
Amy Philo
Go to my website momsandmeds.wordpress.com and do a search on leading researcher Zachary Stowe of Emory who does breastfeeding studies paid for by GSK etc. Conflict of interest??
http://momsandmeds.wordpress.com/2009/06/24/breastmilkexposure/
SUMMARY
BREAST MILK ONLY EXPOSURE
First here is the information on Zoloft which is the recommended drug for breastfeeding (Prozac is the recommended drug for pregnancy).
Zoloft breast milk exposure (3 reports):
Convulsions / Epilepsy; Developmental Delay; Hypotonia
Other drugs collectively – breast milk only exposure:
SOMNOLENCE: 4 reports from breast milk alone – Prozac, Cymbalta, Lexapro and Wellbutrin
SIDS from breast milk alone – Effexor (2 reports)
Fatigue – 1 report – Paxil
Hyperreflexia – 1 Paxil
Insomnia – 1 Celexa, 1 Paxil
Gastrointestinal Disorder – 2 Paxil, 1 Celexa
Gastroesophageal Reflux Disease – 1 Celexa
Feeding Problem – 1 Lexapro
Weight Decreased – 1 Celexa
Sleep Disorder – 1 Prozac, 1 Wellbutrin
Irritability – 1 Prozac
Kidney Enlargement – 1 Paxil
Rash – 1 Paxil
Fractures – 1 Effexor
Bloody Stools / Rectal hemmorage – 1 Prozac
Pregnancy Only Exposure – Neonatal Deaths / SIDS
SIDS: 5 cases – 1 each for Celexa, Effexor, Lexapro, Wellbutrin, and Zyprexa
Neonatal Deaths: 11 cases – 3 for Celexa, 2 for Effexor, 1 Wellbutrin, 5 Zyprexa
COMBINED Breast Milk and Pregnancy Exposure
SIDS – 1 Lexapro, 1 Paxil
Autism / Sensory Integrative Dysfunction – 1 Zoloft
METHOD OF EXPOSURE NOT LISTED
SIDS – 1 Effexor (also a coma / loss of consciousness report).
Regarding studies on the dangers of nursing while taking antidepressants, read this article about a mother whose baby died from being nursed on Effexor. http://uniteforlife.wordpress.com/2009/04/02/mother-speaks-out-effexor-sids-and-the-mothers-act/
I consider this little tidbit of information about delayed lactation kind of significant in that I think it is Nature’s built in back up plan to help protect babies from being exposed to drugs in the breast milk.
The testing needs to consider both the drug in the serum and the metabolite in the serum (the metabolite often being more dangerous). However that will not account for or show the amount collecting in babies’ brains which can be 30 to 100 times higher. The brain of course regulates sleep and breathing so with high concentrations collecting in the brain you can see that the risk for SIDS goes up considerably. When you alter the serotonin system you risk that.
Also, Prozac, Zoloft etc. are all essentially the same kinds of drugs so to say that one causes vomiting, seizures and coma and then turn around and say another drug is safer or “safe” as it is being promoted by many, is both illogical and incredibly irresponsible. This is just a matter of bad science being promoted before testing has truly been done as well as a matter of ignoring all effects on babies and picking and choosing which things to report. The samples have been very small in the few studies that have been conducted and there is no way that any mother should believe a single word that comes out of a drug apologist’s mouth. This is why we have formula. So for those mothers who take antidepressants after birth they can have the peace of mind that they are not drugging their infants and risking their babies’ lives or risking doing irreversible damage to their brains and bodies.
To the commenter who said that there is little to no Zoloft in breast milk, I invite you to look at all of the studies on breast milk and antidepressants and read through my websites and the FDA reports of death and harm to babies exposed via breast milk and really do a critical analysis. Go in and read the individual reports in each of those studies, look at the age, the method of testing, time of testing, baby’s size, dose of the drug, etc. You will find that a single blood test taken at a single moment in time is what they are doing. It does not provide information about those babies that would really give you a clue as to what their amount of breast milk intake was. In some of these studies many of the infants were up to half formula fed or were already on solid food. Not exactly reliable there is it? I even read one study that promoted Zyprexa to nursing mothers based on 6 babies. The follow up on this is all either voluntary reporting by the mother or half-hearted follow up by the doctor where they simply ask if anything has been noticed, they are not really looking for any problems, to say the least.
In short, the “studies” are measuring serum levels of drug in the infant which means that the drug has been through their stomach and gut, metabolized in the liver, and that not much remained in the blood. Whether these studies were well conducted or reliable or large enough samples to make a conclusion is a topic for another time and place but if you are simply going off of what a druggie has to say, then you are going to be wrong 99% of the time.
This infant serum testing does not mean there was no exposure. In fact in the studies they did show exposure existed, so your “little to no” comment makes no sense. How much Zoloft is appropriate to feed an infant? Zoloft is not approved for babies!!! It is NOT safe. It is associated with all sorts of problems - any problem an adult would have and probably more, including the risk of SIDS from sedation, seizures, vomiting, etc. etc. etc. Exposure depends not only on what amount gets into breast milk but also how much milk the infant gets, the time of exposure, and whether it is foremilk or hindmilk.
If you would like to risk drugging your child with Zoloft go right ahead. I have already done this, I was told “It will make your baby happy too.” However, the pediatrician also warned me that it might cause sedation and to watch out for that. That is a SIDS risk factor.
The result in our case has been a child who has hypoglycemia (which can cause severe shaking and brain cell loss if he gets too hungry) and is extremely quick to cry. By the way, hypoglycemia is a precursor to diabetes.
But he was only exposed for about four months and luckily while he was a newborn I was doing half bottle feeding. He was heavily sedated when I first started nursing him on it at 6 days old. Thankfully events intervened to prevent me from feeding him breast-milk-only as a newborn. Otherwise I am afraid he may have died from the heavy sedation.
Here are some additinal links for moms.
http://uniteforlife.wordpress.com/
http://momsandmeds.com/
http://www.cchrint.org/psychdrugdangers/MothersAct.html (look up Zoloft)
http://uniteforlife.wordpress.com/2009/09/05/what-the-media-doesnt-say-about-antidepressants-pregnancy/
Amy Philo
P.S. Vomiting + sedation / seizures = aspiration –> coma, death.
Evelyn Pringle
Let see, we have moms feeling rejected by babies that don’t seem to want to nurse. Then we have moms who’s libido is out of whack from SSRIs trying to get back in the groove of a healthy sex life after giving birth and probably not knowing the drugs are causing the problem. So rejection from the hubby might follow.
Sounds like SSRIs have the potential to bring on a good case of what will no doubt be labeled PPD and the drug peddling can continue perpetually.
And let’s not forget the claims of the gang of disease mongers behind the Mothers Act, that we also have “Sad Daddies” with PPD and other pregnancy related mood disorders that need SSRIs.
I also find it amazing that all these studies are just happening to come out now, after the SSRIs are off patent and all the major money has been made.
Jimmy Joe
Expensive drugs that bring on more expensive treatments, inferior baby formulas, and doctor visits: a medical industry money making fantasy gone wrong or just as planned?
kimbriel
Evelyn: not so amazing… this is Pharma’s MO, and they’ve done it for decades… the only bad news about the first antipsychotics came out when they were cheap, and Pharma had new ones to peddle.
Jedi Mission
I got serotonin syndrome from Prozac 2 years ago and ended up planning a suicide, fell in and out of consciousness for 4 days with a 104 temp, called 911, within days had immune, heart, liver, lung, kidney failure, siezures, and ended up in a 10 coma that took me weeks to come back from. To this day I have brain damage and organ trouble from 5 weeks of that garbage. I have the leg pains I suffered then now- like my muscles are on fire. SSRI’s have NEVER been proven more effective than a placbo- none of them have been.
Further serotonin receptors are EVERYwhere in the body- and many in the bowel. It is a mythical construct- the chemical imbalance, stupid and dangerous. Read Dr. Peter Breggins work.
pharmavet
Just curious, Jedi:
1) What was your starting dose of Prozac?
2) How quickly were you titrated?
3) What was your maintenance dose?
4) How long were you on this dose?
5) Were you on on concomitant serotoniergic drugs.
I only ask these questions because while I acknowledge that other AE’s are common with SSRI’s, fulminant serotonin syndrome is not common and may be related to one of the above factors.
Jenny Hatch
I came off my meds and was sober for a year before conceiving my next baby. After my first child was born I took a cocktail of Lithium, Stelazine, and Prozac for 14 months.
I suffered from terrible hypoglycemia all during my pregnancy (Please note, I was completely off the meds), and my daughter was the most “high need” infant of my five children. She wanted to nurse every twenty minutes, was irritable, never slept, had major meltdowns until she was six and was overall the most difficult of all of my children to mother.
I wonder if anyone in the medication world is doing studies on the long term effects on children AFTER a mother has come off the meds?
Jenny Hatch
http://WWW.NaturalFamilyBLOG.com
Lisa Van Syckel
Pharmavet,.. anyone who is on an ssri can come down with serotonin syndrome, children and adolescents are more susceptible. What Jedi is describing is more indicatve of NMS, ie high fever, muscle problems. Paxil has a NMS warning in its package insert
pharmavet
Lisa is probably correct. The problem with some of these drugs is cross-activation of multiple receptor systems, so that Neuroleptic Malignant Syndrome is certainly a possibility.
antidepressants and weight loss
thank you for great information.