Remeron for Post Partum Anxiety

[sangchee]

I have a three and a half month old and have been experiencing post partum anxiety. I had been using Ativan .5 mg as needed, but my doctor felt it was better to go on an SSRI. I tried Celexa at 10 mg which made the anxiety much worse (it was mild to moderate prior to the Celexa). My psychiatrist recommended Remeron (Mirtazapine at 7 mg) and I am starting it tonight, which she believes to be safe to take while exclusively breastfeeding.

My questions are:
Is this safe to take while breastfeeding (I solely breastfeed currently, but will change to formula if necessary)
My doctor also recommended taking Ativan as needed if I experience breakthrough anxiety during the initial period of taking Remeron. Is this combination of Ativan and Remeron safe for the baby? And if not, would pumping and dumping be recommended, or would ceasing breastfeeding be the safer alternative during this initial period?

Thank you.

[cpride]

Dear sangchee,

Mirtazapine (Remeron) is an anti-depressant. Minimal amounts enter the breastmilk with a relative infant dose (RID), the amount of your dose that enters breastmilk, of 1.6-6.3 percent of the maternal dose. Medications that have less than a 10 percent RID are usually compatible with breastfeeding. No adverse effects or delays in developmental milestones have been reported from breastfed infants of mothers on mirtazapine.But this is an antidepressant with strong sedative properties. Observe your infant for sedation. Consider alternatives such as sertraline (Zoloft), venlafaxine (Effexor), or paroxetine (Paxil) if your infant has difficulty with sedation. The time Remeron is most concentrated in your milk is at two hours after the dose so breastfeed first then take your dose and wait past two hours to reduce the amount of medication your infant is exposed to. Ativan (lorazepam) may also cause sedation. You are on a low dose and taking occasional doses is probably compatible with breastfeeding. Taking two medications together that cause sedation may increase the risk of sedation so be sure to observe your infant. The time Ativan is most concentrated in your milk is also two hours after your dose so again avoid breastfeeding at the time of highest concentration. The RID of lorazepam is 2.6 to 2.9 percent of your dose which is small. Hope this information is helpful. If you have further questions, please call the InfantRisk Center at 806-352-2519. We are open Monday through Friday 8 to 5 CDT.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center

[OSW]

Hello,

I am currently on 45 mg Mirtazapine (Remeron) and am 18 weeks pregnant. Is it safe to remain on this dose and breastfeed? Thank you.

[cpride]

Dear OSW,

Mirtazapine (Remeron) is an anti-depressant. Minimal amounts enter the breastmilk with a relative infant dose of 1.6-6.3% of maternal dose. No adverse effects or delays in developmental milestones have been reported from breastfed infants of mothers on mirtazapine. However, this is an antidepressant with strong sedative properties. Observe your infant for sedation. Avoid breastfeeding for two hours after taking your dose. Consider alternatives such as sertraline, venlafaxine, or paroxetine.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center