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  1. #1
    prideNJoy's Avatar
    prideNJoy is offline October ~ Vaccine Injury Awareness Month
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    Unhappy PMDD & breastfeeding

    I've just been diagnosed with PMDD.

    I'm now in a very hard situation, as i need to either take the 'Yaz' pill which is specifically made/used for people who suffer PMDD or anti-depressant's.
    Problem with Yaz is it's a combination pill which isn't recommended for use in breastfeeding mother's.
    I showed some info i printed out from the kellymom website to my Dr. (whom also checked with another of her fellow Dr.s) that states.... below
    But they both said that i can't breastfeed and take this pill.

    It's recommended that any estrogen-containing contraceptive be avoided until baby is at least six months old AND after baby is well-established on solid foods.
    Milk supply: Estrogen-containing contraceptives have been linked to low milk supply and a shorter duration of breastfeeding even when started when baby is older, after milk supply is well established. Not all mothers who take contraceptives containing estrogen will experience a low milk supply, but these unaffected mothers appear to be a very small minority.
    Safety: Both progestin (progesterone) and estrogen are approved by the American Academy of Pediatrics (AAP) for use in breastfeeding mothers. See below for additional information on side effects related to lactation.

    Milk supply: As noted above, hormonal birth control pills (particularly those containing estrogen) have the potential to decrease milk supply, sometimes dramatically.
    Effects on baby: There have been no adverse reports of side effects to the baby. Both progestin and estrogen are approved by the AAP for use by nursing moms. Children whose mothers used hormonal birth control while nursing have been followed as late as 17 years of age. The exception to this is the very young baby - less than 6 weeks old. There may be some concern about the baby's immature liver being able to metabolize the hormones passed through the milk well enough.
    Any hormonal birth control may cause fussiness in the baby (not reported in the literature but often anecdotally by mothers). This may be due to the hormones causing a minimal decrease in the protein/nitrogen/lactose content of the milk. Some mothers have reported marked improvement in their baby's degree of fussiness once they come off hormonal birth contro



    I don't know what i'm hoping to achieve really from this post, maybe someone who has been through the same thing and continued breastfeeding? And had no problems with it affecting their bub?

    Maybe getting a 3rd opinion?

    DS is 14 months now btw, and i didn't think our breastfeeding relationship would come to an end like this.
    I can't even look at him atm without nearly bursting into tears at the thought of not feeding him.
    I know this wil probably seem petty to all those women who weren't able to breastfeed for whatever reason, but i can't help the way i feel.

  2. #2
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    oh hun! im so sorry! i have no idea but wanted to come and give you some
    DS1 - Brayden Robert - 25th October 2005
    DS2 - Harlan Daniel - 2nd May 2008
    and introducing Kaizen Marshall - 29th May 2010

  3. #3
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    hey hun..

    I was diagnosed with PMDD over a year ago...

    are you on any other pill now? (mini etc..)

    I actually found that coming off the pill I was on was the best treatment

  4. #4
    prideNJoy's Avatar
    prideNJoy is offline October ~ Vaccine Injury Awareness Month
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    Quote Originally Posted by myQTBoys View Post
    oh hun! im so sorry! i have no idea but wanted to come and give you some
    thanks Mel

    Quote Originally Posted by TwoBlue View Post
    hey hun..

    I was diagnosed with PMDD over a year ago...

    are you on any other pill now? (mini etc..)

    I actually found that coming off the pill I was on was the best treatment
    to you TwoBlue, how are you dealing with it now?

    I havn't been on any pill at all. My symptoms are getting worse, which is why i feel i need to do something about it soon.

    I asked about St.Johns Wort too, whether that was an option and that's still a no go, and even then i wouldn't be able to take any other medications whilst taking it whatsoever, so no mulit-vitamins/pill/anti-depressant's etc etc..

  5. #5
    MilkingMaid's Avatar
    MilkingMaid is offline Winner 2009 - Mod Award - most supportive member
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    so just normal anti d's are out of the question? Paxil, Zoloft and citalopram are OK for breastfeeding...none of them able to help?
    Yoga Mum to 3 boys..



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    I still struggle alot.. I was on Anti depressants for a little over a year.. started slowly coming off them recently so that I could TTC.. once I was off them I found myself getting really bad again .. but by coming off the contraceptive pill I was on helped alot.. I also take vit b supps which was a recommendation.. I feel alot better lately but still struggle cycle to cycle...

    Its so not easy.. its SO SO hard....

    I guess from a personal viewpoint and not at all dismissing your breastfeeding relationship which I applaud you for... I know what I would chose... If you were anything like I used to be.. I'd take the tabs...

    You have to do whats right for you and your family but know this.. you deserve to feel happy

    ask me anything, anytime...

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    Quote Originally Posted by ApprenticeMomma View Post
    so just normal anti d's are out of the question? Paxil, Zoloft and citalopram are OK for breastfeeding...none of them able to help?
    I was put on Lovan for it.. not sure if thats ok for B'feeding or not?

  8. #8
    MilkingMaid's Avatar
    MilkingMaid is offline Winner 2009 - Mod Award - most supportive member
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    Lovan is one you cannot breastfeed while taking.
    Yoga Mum to 3 boys..



  9. #9
    prideNJoy's Avatar
    prideNJoy is offline October ~ Vaccine Injury Awareness Month
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    Quote Originally Posted by ApprenticeMomma View Post
    so just normal anti d's are out of the question? Paxil, Zoloft and citalopram are OK for breastfeeding...none of them able to help?
    I asked about Anti-D's and was told that nothing was suitable while breastfeeding.

    Apparently this Yaz pill is the best option.

    Quote Originally Posted by TwoBlue View Post
    I still struggle alot.. I was on Anti depressants for a little over a year.. started slowly coming off them recently so that I could TTC.. once I was off them I found myself getting really bad again .. but by coming off the contraceptive pill I was on helped alot.. I also take vit b supps which was a recommendation.. I feel alot better lately but still struggle cycle to cycle...

    Its so not easy.. its SO SO hard....

    I guess from a personal viewpoint and not at all dismissing your breastfeeding relationship which I applaud you for... I know what I would chose... If you were anything like I used to be.. I'd take the tabs...

    You have to do whats right for you and your family but know this.. you deserve to feel happy

    ask me anything, anytime...

    I know that i have too, i just don't wanna stop feeding my boy! It just breaks my heart thinking about it. He would probably be quite content having formula, but it's not the same.

    It's like having an evil twin, two totally different people. That's what it feels like anyway.

    Thanks TwoBlue,

  10. #10
    MilkingMaid's Avatar
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    Have a read of this article, you certainly CAN take antidepressants and breastfeed, I have done it (I was on citalopram for a year while breastfeeding) and I know many others who have also. I personally asked for Paxil or Zoloft, but in NZ, where I was at the time, they are not subsidised by the gov, so are very expensive, so I went with citalopram instead, and it saved my life, literally, and I was the same as you, stopping breastfeeding would have absolutely crushed me.

    I guess it just depends if that particular class of drugs (SSRI's) are going to be effective for PMDD.

    www.kellymom.com

    Using Antidepressants in Breastfeeding Mothers

    Keynote address by Thomas Hale, PhD

    LLL of Illinois Area Conference, Bloomingdale, IL
    October 26, 2002

    Attendee's report by Eva Lyford
    reviewed & edited by Thomas Hale, PhD

    published at kellymom.com with permission from Eva Lyford and Thomas Hale, PhD

    Dr. Hale provided an insightful and fact filled presentation on treating depression in nursing moms. For reference on items contained below, see Medications & Mothers' Milk, 2004 by Thomas Hale. Notes are arranged as follows:

    Highlights
    SSRI improvements over older drugs
    SSRI sequence of effects
    Specific drugs
    Prozac
    Zoloft
    Paxil
    Celexa
    Effexor
    St. Johns Wort
    Bupropion
    Lithium
    Valium
    Tricyclics
    Drug Hierarchy
    Concluding remarks

    Highlights

    Highlights were that:

    The effects of an untreated depressed mom on the infant are significant and hazardous; but the marginal effects of any medication usually are less hazardous than those effects. Treating a mom with postpartum depression (PPD) is much preferable to not treating, since a baby has a better outcome generally (as measured by Bayley scores, measuring interaction skills and speech and language development) when being cared for by a non-depressed parent.
    PPD is significantly more dangerous compared to depression outside of postpartum; PPD patients are sometimes more likely to commit suicide, and need to be treated with due haste. Waiting to wean before starting medication is not a sound option. Also, weaning in order to treat is not a good choice due to the loss of the positive effects of breastfeeding. The rate of depression in the general population in an individual's lifetime is between 3% and 17%. However, in the postpartum population depression is about 15%, and is often more severe. For example, it moves to psychosis more frequently.
    In all studies thus far, any negative effects of medication usually occur in the first 30-60 days postpartum, so breastfeeding beyond that and taking medication is usually fine.
    Babies exposed in utero can suffer "discontinuation syndrome" (a.k.a. withdrawal effects) but sometimes this is misdiagnosed as a reaction to the continued medications in mom's milk, when really the milk transfer rate for many of the SSRIs is negligible.
    SSRI improvements over older drugs
    The SSRI family of antidepressants is significantly improved over older antidepressants as follows:

    Not addictive
    No associated buzz
    Mild withdrawal or "discontinuation syndrome" in some patients
    More rapid onset as compared to older tricyclics
    Side effects generally wane over time
    Reported 60%-70% response rate in patients.
    SSRI sequence of effects
    The sequence of effects for SSRIs is as follows:

    Sleep and anxiety normalize within the 1st week
    Motivation, interest, hopefulness and appetite return within 2nd and 3rd week
    Mood and libido may improve after (libido may worsen)
    Specific drugs
    Specific drugs discussed:

    Prozac is the only drug "cleared by the FDA" for use during pregnancy. A mother on Prozac during pregnancy may wish to change drugs before birth or immediately after, or titrate the dose down in the last trimester since the existing blood plasma level in the newborn fetus plus the drug transfer through milk may lead to toxicity. Its effects on the breastfed infant have been reported in infants 2 months old or less.

    Zoloft is the "best drug choice so far". It has a low, low transfer rate to breastmilk (17-173 ug/liter) in mothers taking up to 150 mg/day. In one excellent study of 11 mother/infant pairs, the zoloft was undetectable in 7 of the 11 breastfeeding infants' serum and minimal in the other infants. In two other studies of one and three mother/infant pairs respectively, zoloft was undetectable in the plasma of all 4 infants. A theoretical concern with Zoloft is that some babies may not gain weight as rapidly or as well when breastfed by moms on Zoloft; so weight gain should be monitored and dosage tweaked as necessary.

    Paxil has low blood plasma levels in the mother, and a low transfer rate to human milk. It was undetected in the blood plasma of 7 of 8 breastfed infants in one study, all 16 of the infants in a second study, and all 24 of the infants in a third study. For babies exposed to paxil in utero, there is evidence that withdrawal may occur 24-48 hours after birth.

    Celexa (citalopram) has a 4.3-16 nanogram/kg blood plasma level, but transfer rate is higher via milk. Use with caution and watch infant for side effects (per Hale, "There have been two cases of excessive somnolence, decreased feeding, and weight loss in breastfed infants.").

    Effexor is a popular drug for treating depression in Australia. It is less popular here in the USA due to reported side effects. Effexor can also be used in breastfeeding mothers if it is efficacious. It may be effective against hyperactivity. It is an SSRI and NRI.

    St. John's Wort is a weak SSRI. It also stimulates liver enzymes and may enhance the metabolism of other drugs. German varieties are found to be the most pure in independent testing; other brands may have contaminates and not be very pure. Documented drug-drug interactions have been found; the action of St. John's Wort on the liver can accentuate the metabolism of many drugs. For example, St. John's Wort may reduce the efficacy of birth control pill regimens, although this has not been documented.
    Bupropion has a high milk to plasma ratio, and is excellent for use in smoking cessation programs. It may reduce the milk supply but as yet this is undocumented.

    Lithium use by the breastfeeding mother is dangerous to the breastfed infant.

    Valium use by the breastfeeding mother entails a greater risk of infant sedation, and may perhaps increase the risk of SIDS.

    Tricyclics - many have significant side effects in mothers including dry mouth, constipation and other anticholinergic symptoms. Thus they are not overly popular with patients. Generally, tricyclics have a poor transfer to milk with the exception of Doxepin, which has a higher transfer rate. Long-term effects are unknown.

    Drug Hierarchy

    When choosing a medication SSRIs are generally the preferred choice for a breastfeeding mother. Side effects from SSRIs are most common in the first 3 months postpartum; so with an older baby, there is little concern. Hale's "choice hierarchy" is as follows:

    Zoloft
    Paxil
    Celexa
    Effexor
    Prozac

    Concluding remarks

    Finally, Dr. Hale concluded his talk by saying that breastfeeding should be supported fully and not interrupted by mom's needs for medication; and that treatment of postpartum depression can be accomplished relatively safely in breastfeeding mothers. So, in his consideration, moms should continue breastfeeding and should get drug treatment as needed for depression.
    Yoga Mum to 3 boys..




 

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