Starting a new antidepressant

[MKStone]

I was on Celexa 40mg per day before I became pregnant with my last child (#3). I quit taking the medication as soon as I found out that I was pregnant. She's now 4 months and I'd like to start taking an antidepressant again (taking it for anxiety). My pediatrician suggested Zoloft or Paxil for their safety profiles. I have taken Zoloft in the past with no effect. My PCP gave me a prescription for Paxil (20mg), but told me that if my daughter wakes during the night to eat and it's been less than 4 hours since I took the Paxil (I was planning to take it before bed to lengthen the time between my dose and her breastfeeding), that I should feed her pumped milk. Some nights she doesn't sleep for a 4 hour stretch and I don't have enough expressed milk to do this on a regular basis.

My PCP scared me and has made me worried to take this medication - I'm considering waiting until she's older and is sleeping more consistently before starting it - though I really think that I'd benefit from starting it now. Is it really necessary to wait a full 4 hours?

Thanks,
Kate

[admin]

MKStone:

Another good choice might be Lexapro, which is the active metabolite of Celexa. It costs more, but probably has fewer side effects on the infant. Levels transferred are about 5-8% of your dose, however studies generally find that it is undetectable in the infants plasma, which is good. Its also beneficial that you are 4 months postpartum. Your baby will better handle any small amounts present in milk. At this point, I'd think that the risk of untreated maternal depression is far greater than the risk of the small amount of medication in breastmilk.

Paxil levels are even lower in milk, but no one ever knows which antidepressant will work on the individual patient. So if celexa or Lexapro works, use one of them. Remember, a healthy mom makes a MUCH healthier child...



Tom Hale PhD.

[MKStone]

The dose of Celexa that was recommended by my obstetrician was 20mg, but I was not helped by the 20mg before and I was bumped up to the 40mg dose. My insurance won't cover Lexapro unless I first "fail" Celexa. I haven't tried to get a waiver because of the breastfeeding concerns, but I'm sure that's possible.

I thought I'd try the Paxil since it's levels are lower, and hopefully it will work for me. If not, I will consider going with Celexa/Lexapro. With the Paxil - if my baby wants to eat less than 4 hours from me taking the Paxil, should I feed pumped milk or is it ok to nurse her, as long as this only happens occasionally?

Thanks,
Kate

[cpride]

Dear MKStone,

Paxil (paroxetine) enters breastmilk in minimal amounts. The time the medication is highest in your milk is five to eight hours after you take your dose so try to avoid that time, if possible. Observe your infant for sedation and constipation.

Sincerely,
Cindy Pride, MSN, CPNP
TTUHSC InfantRisk Center