What Are the Safest Antidepressants While Nursing?
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Key takeaways:
Postpartum depression (PPD) is common among new parents who experience the “baby blues” for longer than 2 weeks after childbirth.
Many medications can be used to treat PPD — your healthcare provider can help choose the best medication for you.
Some parents may prefer medication-free options due to potential concerns over negative effects on nursing babies.
With so many overwhelming changes after childbirth, it’s normal to experience feelings of sadness and emptiness for a few days. But after 3 to 5 days, these “baby blues” usually go away. For many parents, however, these feelings might lead to postpartum depression (PPD) — depression that develops shortly after child birth — which lasts longer than 2 weeks.
Some parents may not share their symptoms with anyone due to feelings of embarrassment for not being happy and shame for being seen as a bad parent. Also, due to concerns about the potentially negative effects of some medications on nursing babies, some parents may prefer medication-free choices to help treat PPD.
Although medication-free therapies are a possibility, there are some medications that have little to no side effects for nursing babies and are also effective for the parent’s symptoms.
Here, we will discuss depression after pregnancy and the different treatment selections for PPD.
How common is PPD?
PPD is common for many parents, with 1 in 9 parents who gave birth having PPD. Although many new parents may have the baby blues for 3 to 5 days after childbirth, some may experience these baby blues for longer than 2 weeks.
In addition to feeling sad and empty, they might experience some of the following symptoms:
Sleeping too little or too much
Crying a lot
Feeling very tired
Having no motivation
Having trouble focusing
Having memory issues
Feeling worthless or guilty
What’s the risk of taking certain medications while nursing?
Nursing a child has many health benefits. In addition to providing nutrients to a baby, human breast milk lowers a baby’s risk of getting various infections. Nursing a baby for about 6 months after childbirth also provides additional benefits during and after early childhood. Some of these benefits include a lower risk of:
But if a nursing parent takes medications, there’s a chance that the medication can get to a nursing baby through the parent’s milk.
Codeine is a well-known example of a medication that is broken down in our bodies to morphine, which can be also present in a parent’s milk. A nursing baby can be exposed to morphine through milk, and this can cause symptoms of an opioid overdose. Other example medications to consider avoiding while nursing include:
Amiodarone: This medication can cause potential heart and thyroid effects in nursing babies.
Aspirin: Children under 16 years old that take or are exposed to aspirin might develop Reye’s syndrome, a condition that causes brain and liver swelling.
Cannabis: Cannabis might negatively affect brain development.
These examples show some of the reasons that many nursing parents prefer medication-free treatment options. Sometimes, it may seem easier to play it safe and avoid medications altogether.
Fortunately, there are several medications available that are appropriate for nursing parents to use to treat PPD. These are detailed below.
What are the safest antidepressants to take while nursing?
There are many antidepressants available, so which one would be the best for you and your baby? To answer this question, you and your healthcare provider should first sort through some of the following factors:
Are your PPD symptoms mild, moderate, or severe?
What are the risks to not treating PPD?
What are the risks of taking an antidepressant while nursing?
Have you had success with a certain antidepressant in the past?
Did you take an antidepressant during your pregnancy? If so, did you have success with a certain one?
How strong is your desire to nurse your baby?
What are the disadvantages to not nursing your baby?
Nonetheless, the first-choice treatments for PPD while nursing are from a medication class called selective serotonin reuptake inhibitors (SSRIs). Nursing parents in several studies experienced an improvement in PPD symptoms while taking an SSRI.
Next, we’ll discuss more about SSRIs and other medications available to treat postpartum depression.
Selective serotonin reuptake inhibitors (SSRIs)
As previously mentioned, SSRIs are first-choice medications for treating PPD. SSRIs work by raising the amount of serotonin in our brains — a chemical that affects mood.
Within the SSRI class, the first go-to option is usually sertraline (Zoloft) due to low amounts that pass into the parent’s milk. Furthermore, there is no clear link between sertraline and negative effects on nursing babies.
While nursing, paroxetine (Paxil) is another first-choice SSRI for similar reasons as sertraline. However, it does have some disadvantages:
If paroxetine is taken during pregnancy — particularly the first trimester — it may raise the child’s risk for heart defects. If a person with PPD is considering getting pregnant again in the future, paroxetine may not be the best option.
If the nursing parent accidentally misses a few doses due to the many overwhelming changes after childbirth, they might experience withdrawal symptoms, which include nausea, dizziness, trouble with sleep, and anxiety. The risk of these withdrawal symptoms may be higher with paroxetine than with other SSRIs.
If SSRIs cannot be used or if they’re not effective, other options are available. These are discussed next.
Tricyclic antidepressants (TCAs)
Although tricyclic antidepressants (TCAs) aren’t frequently used due to potential concerns of certain heart problems with high doses and other side effects, some experts consider nortriptyline and imipramine as another antidepressant of choice in nursing parents. This is because both nortriptyline and imipramine aren’t commonly found in parents’ milk, and there are no reports of negative effects in nursing babies.
Nortriptyline and imipramine are thought to affect our mood by influencing naturally-occurring brain chemicals, such as norepinephrine.
Serotonin-norepinephrine reuptake inhibitors (SNRIs)
Another antidepressant medication class — serotonin-norepinephrine reuptake inhibitors (SNRIs) — can also be used to treat PPD while nursing. SNRIs improve mood by raising the amount of certain naturally-occurring chemicals in the brain — serotonin, norepinephrine, and sometimes dopamine.
Within the SNRI class, venlafaxine (Effexor) and duloxetine (Cymbalta) are potential medication options. Similar to above, there are no reports of negative effects with venlafaxine in nursing babies.
However, compared to other antidepressants, venlafaxine and duloxetine have less available safety data in nursing babies. Furthermore, preliminary findings show that venlafaxine is present in high amounts in parents’ milk. Although nursing parents experience fewer PPD symptoms while taking venlafaxine and there’s a low amount of duloxetine in breast milk, these two medications are not first-choice options.
Mirtazapine
Mirtazapine (Remeron) is an atypical antidepressant that is thought to work by helping improve the availability of serotonin and norepinephrine in the brain.
Like sertraline and paroxetine, there’s a low amount of mirtazapine in parents’ milk that would ultimately affect a nursing baby. However, similar to venlafaxine and duloxetine, there is little safety data about mirtazapine in nursing babies. For this reason, it’s also not a first-choice option for PPD.
Bupropion
Bupropion (Wellbutrin) is another antidepressant that’s thought to improve mood by raising norepinephrine and dopamine in the brain.
Like the first-choice medications, there is a low amount of bupropion in breast milk. So, negative effects from bupropion are unlikely in nursing babies. However, there are very rare reports of seizures in a few nursing babies.
Which antidepressants should I avoid while nursing?
In general, antidepressants with the following characteristics are usually not first-choice options:
Medications that frequently can be found in a parent’s milk
Medications that negatively affect nursing babies
Medications with little information about their effects on nursing babies
Medications with little evidence to support their effectiveness for nursing parents
In particular, however, try to avoid fluoxetine (Prozac) and citalopram (Celexa) — they’re both SSRIs. These medications are known to go into the parent’s milk and can be risky for babies. Fluoxetine may cause colic, fussiness, drowsiness, and weight changes. Citalopram may cause weight loss and drowsiness.
With this in mind, however, don’t stop or switch away from these medications if you were already taking them during pregnancy or if no other medications are effective for your symptoms. If you have any concerns, please speak to your healthcare provider.
Treating PPD is very important for you and your baby’s health. Doing so will help you carry out your day-to-day activities, prevent negative effects on the baby’s development, and encourage a healthy relationship between you and your baby.
Therefore, if necessary, healthcare providers will probably recommend a medication to help treat PPD if you experience it. Depending on the medication choice, they might monitor the nursing baby for side effects over time.
Can I treat PPD without medications?
If you’re experiencing PPD symptoms, please reach out to a therapist, psychologist, or social worker. These professionals might help you learn some coping strategies to change how depression makes you think, feel, or act. They can also refer you to other resources that may be available.
But, if therapy is not effective or if you still experience moderate to severe symptoms, know that medication treatment is an appropriate option to try with or without therapy.
The bottom line
Depression after pregnancy is a common condition among new parents. Depending on the severity of symptoms, therapy and medications are potential options for the treatment of PPD.
If you and your healthcare provider decide that using a medication would be appropriate, experts usually consider sertraline as a first-choice option. Other preferred options for nursing parents include paroxetine, nortriptyline, and imipramine. But first-choice medications might not work for everyone, and the “best” medication varies from person-to-person.
With all of this in mind, talking with your healthcare provider is important to help you determine the best option for you and your baby’s health.
ABOUT THE AUTHOR:
Ross earned her doctorate in pharmacy (PharmD) at The University of Texas at Austin (UT Austin). Her years of experience practicing in various pharmacy settings also lead to multiple board certifications, including ambulatory care, geriatrics, and pharmacotherapy. She currently serves as the director of the PharmacyChecker international verification program.
Ross also founded Off Script Consults, a pharmacy consulting business. She strives to combine her passion for pharmacy, education, and writing to improve the quality of life and financial outcomes for people with chronic medical conditions, caregivers, and healthcare providers.
She particularly enjoys creating relatable and helpful content for her readers and viewers. For writing samples, please visit her Muck Rack portfolio. For videos, please visit her “Off Script Consults” YouTube channel.
Ross currently resides with her husband and two dogs in her home state of Texas to be closer to family. She also tries to find time for hobbies, which include rock climbing, running, and playing pickle ball.
Find out more about Ross via phone, e-mail, or social media (LinkedIn, TikTok, Instagram, Twitter, Facebook, and Pinterest).