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Hello, I have been for a couple of months in alplazolam and then switched to lorazepam, I was doing good with my PTSD and generalized anxiety but today I had another panic attack and my Doctor want us to talk about a more long term medication, I want to go with information and prepared, can you please suggest me good options to discuss with him? He has mention Paxil and Prozac but I think I would feel better on Zoloft, I really want to keep breastfeeding with all my hard but I don't want to hurt my baby acting selfish, can you please tell me good options and risks? Thank you so much.
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Buttercup,
Zoloft (sertraline) is rated an L1-extensive data-compatible. The amount transferred into breast milk is 0.4-2.2% of your dose. [COLOR=#333333][FONT=lucida grande]Sertraline has been extensively studied in many breastfeeding mothers. The data is consistent that levels in milk are quite low and do not normally affect an infant. Sertraline is a preferred antidepressant. Monitor the infant for sedation or irritability, not waking to feed/poor feeding and weight gain.
Prozac (fluoxetine) is rated an L2-limited data-probably compatible. The amount transferred is 1.6-14.6% of your dose. [/FONT][/COLOR][COLOR=#333333][FONT=lucida grande]There have been some reports of mild complications, but they may actually be attributable to a discontinuation syndrome rather than toxicity from the medication. [/FONT][/COLOR][COLOR=#333333][FONT=lucida grande]While sertraline and escitalopram levels in milk are probably lower, fluoxetine is quite suitable for breastfeeding mothers and their infants. Monitor for sedation or irritability, not waking to feed/poor feeding and weight gain.[/FONT][/COLOR]
Paxil (paroxetine) is rated an L2-significant data-compatible. The amount transferred into milk is 1.2-2.8% of your dose. [COLOR=#333333][FONT=lucida grande]Levels in milk are quite low and average less than 2.8% of the maternal dose. Probably quite safe in breastfeeding mothers. Monitor the infant for s[/FONT][/COLOR][COLOR=#333333][FONT=lucida grande]edation or irritability, not waking to feed/poor feeding and weight gain.
Lexapro (escitalopram) is rated an L2-limited data-probably compatible. The amount transferred is 5.2-7.9% of your dose. Recent and good data now show that levels in milk are low, and that plasma levels of escitalopram are low to undetectable in most infants. While the number of case reports in the literature are still low, it would appear this medication is suitable to use in breastfeeding mothers. Monitor the infant for sedation or irritability, not waking to feed/poor feeding and weight gain.
Any of these medications are probably ok. [/FONT][/COLOR][COLOR=#333333][FONT=lucida grande]Remember, the risk of untreated depression is far higher than the risks of these medications. [/FONT][/COLOR][COLOR=#333333][FONT=lucida grande]I hope this helps.
Sandra Lovato R.N.
InfantRisk Center
806-352-2519[/FONT][/COLOR]
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