I was on two antidepressants while I was pregnant with my second son: Zoloft and Wellbutrin. I needed them desperately. I had a history of depression as a child, and I had also suffered from prenatal depression during my first pregnancy. I was worried about taking both when I was pregnant, but I knew they were generally regarded as safe, so I weighed the risks and benefits and ultimately felt OK about my decision. I did, however, stress out about taking antidepressants while breastfeeding, even though I don't regret my choice to do so.
I knew that I needed both drugs. When I took them alone, the Zoloft turned me into a zombie (the psychiatrists call it “flat affect”), and the Wellbutrin didn’t adequately treat my anxiety. But together, they worked their magic. I started seeing my new doctor mid-pregnancy, after my previous doctor had refused to refill my Wellbutrin due to what she claimed was a risk of seizure. (There have been case reports of babies having seizures after their mothers took Wellbutrin while breastfeeding.)
My new doctor told me what to expect about taking two drugs while breastfeeding. According to one study, she said, Wellbutrin is undetectable in the blood of breastfeeding infants, and Zoloft is also purported to be the safest antidepressant to take while breastfeeding. My new doctor also knew about the case reports of seizures, but she brushed off the study, saying it was too small to be conclusive. She was one of the best in the field, and I trusted her opinion. I felt that I was on two very safe drugs.
Once my doctor cleared me for safety, she told me that I should time nursing around the drugs to ensure that the baby received as little of the drugs as possible. The three main Wellbutrin metabolites (the molecules in a medication that are broken down by your body) peaked at around 1-2 hours, so she recommended that I take the drug in the morning, just after I started nursing if possible, and do my damndest not to nurse again for three hours. On the other hand, she said, Zoloft was most concentrated in breast milk nine hours after a dose, so I should avoid nursing then as well.
I kept freaking out: should I take it? When should I then avoid nursing? Should I wait to take it? Should I not take it at all?
Like most things with babies, this scheduling didn’t go according to plan. I kept forgetting to take my Wellbutrin first thing after nursing in the morning, and not remembering until later in the day. I kept freaking out: should I take it? When should I then avoid nursing? Should I wait to take it? Should I not take it at all. I was nursing a newborn on demand, and as everyone knows, they’re completely unpredictable. Sometimes I’d be able to time my nursing sessions around the times my antidepressants would be at their peak amounts in my milk; but other times, I was faced with a red-faced, screaming baby who wanted to suckle for comfort. So on the boob he went.
I knew I desperately needed my medication, but I was terrified about the long-term effects of breastfeeding on antidepressants. To make matters worse, we later discovered that my son was allergic to milk and soy proteins, which meant formula wasn't an option for him. (It was also way out of our price range.) I couldn’t find any information about the long term effects of Wellbutrin on breastfed infants; what if they found out it caused something horrible later in life, like cancer or heart disease? One study recommended throwing out the breast milk of mothers who took Zoloft at nine hours post-dose. Was it really that bad? Would it have detrimental effects on his health later in life?
Just as I took a calculated risk by taking the drugs during pregnancy, I took a calculated risk breastfeeding on antidepressants, based on what knowledge I had and what I thought would be the best outcome for both of us.
August nursed on demand until he was 2 and a half, and morning and night until he was 4. He grew up fine. At almost 6, he’s now working hard at learning to read. We suspect that he might have ADHD, but ADHD has a genetic component, and both his father and I have been diagnosed with the condition, as has his older brother. Although I did continue to worry about nursing, I eventually gave up on timing nursing sessions; he never seemed to suffer any negative effects from it.
Just as I took a calculated risk by taking the drugs during pregnancy, I took a calculated risk breastfeeding on antidepressants, based on what knowledge I had and what I thought would be the best outcome for both of us. It was like so many choices I'd have so many times in parenting: you do what you do with the best knowledge you have available. Some might say I’m letting Big Pharma play roulette with my kid’s brain chemistry, and maybe that’s true. But I also know that having a depressed mother has documented negative effects on your family.
I took antidepressants while nursing with my third son as well. He’s 3 and a half, still nursing once a day (at night), and he's totally fine. I no longer take Zoloft, but he doesn’t happen to nurse at the time Wellbutrin would be at its peak in my breast milk.
I worry periodically about the effects the drugs may have had. But I needed them, because my depression is not the kind that can be treated by massage or light therapy. My kids have a happy, functional mother. And that, in the end, is what I think matters most.