St. Johns Wort and GABA supplement vs. chronic alcohol use in a breastfeeding mother

[skaran]

Hello everyone, I'm hoping I can get some info/recommendations here. The supplements I am considering are St. John's Wort 300mg and PharmaGABA 200mg.

I am a breastfeeding mother with alcohol addiction. Trying to quit. I have consulted with therapists and a psychiatrist, and will be going to therapy (individual and group) moving forward, as well as looking into AA meetings. I have a history of depression (some postpartum), anxiety, OCD. I've taken Zoloft in the past and experienced adverse effects ("numbing" of all feelings, total lack of sex drive). Finding an antidepressant that will work for me and be safe during breastfeeding has been a struggle.

My biggest issue right now is the alcohol, and I've been doing reading on how that affects everything else. It's clear the biggest things that alcohol affects are GABA receptors and dopamine. The psychiatrist also seemed to think that an antidepressant that affects serotonin/norepinephrine might help me, but the SNRI we were considering did not have enough data during breastfeeding.

I understand herbal supplements have little data in breastfeeding mothers... so do most antidepressants other than SSRIs unfortunately, and even SSRIs have potential adverse effects (as well as my own past experience). So I am trying to make the best decision for myself with the limited information available. Drinking too much while breastfeeding is also not great. Although the alcohol level in breastmilk parallels BAC so ultimately the alcohol that the baby would be affected by is quite low (and this has been an "excuse" for me to keep drinking). I would really like to quit. Alcohol withdrawal can be very dangerous, and the standard medication to protect against that is opioids, which are again not safe with breastfeeding. The biggest danger seems to be seizures due to the way alcohol overloads GABA receptors and so a sudden drop in GABA can result in seizures. This makes me think a GABA supplement might be a very good option.

I'm also considering taking St. John's Wort because from available research, it appears to inhibit reuptake of serotonin, norepinephrine, and dopamine, without having negative effects on sex drive -- so basically everything I'm looking for in an antidepressant. We've considered wellbutrin, venlafaxine, and prozac as well -- I've read the LactMed pages on them all, and none of them seem safe without adverse effects on a breastfeeding infant.

Anyone with expertise here -- what would be your opinion? I have these 2 supplements on hand: PharmaGABA 200mg and St. John's Wort 300mg. I'm considering quitting cold turkey from alcohol tomorrow and taking these instead. Currently drinking 50-60oz of beer daily, 4.2% ABV. If these supplements would be okay for my baby (or at least better than the chronic drinking) then I'll do it, and just go to the hospital if I'm having severe withdrawal symptoms.

Thoughts?

Thanks in advance.

[admin]

Skaran:

First, the most important think you can do for your pregnancy is to STOP alcohol ASAP. It is a known teratogen and is known to produce major brain damage to a fetus. Whatever you have to do, or take, please stop using alcohol as soon as possible. Alcohol is the most well known agent to produce birth defects...

Talk with your therapist or doctor, there are LOTS of really good antidepressants that are safe in pregnancy. We all know that choosing an antidepressant that works in a certain patient is just the luck of the draw, so we often suggest doctors try one. If it doesn't work, try another one. NO one knows which antidepressant will work in a select patient, so you can't give up on antidepressants. As for no data in pregnant patients and antidepressants, we have tons of literature on this family in the pregnant and breastfeeding mother. I'd bet that 80% of depression in pregnant mothers is treated with Sertraline(Zoloft), but lots of other new antidepressants are probably just as safe. This family is MANY times safer than alcohol. Remember, NO antidepressant works over night, most take about a month to really start working...so don't expect an overnight result.

As for St. John's wort. It slows, or stops, the metabolism of many many drugs so much so that you can increase plasma levels of these drugs many times. Thus it can double the levels of MANY drugs just by consuming SJW, so we NEVER EVER suggest anyone use this drug because of this major drug-drug contraindication.

Don't use GABA supplements, as we know nothing about their safety in pregnancy, and we don't think they actually work at all.

Lastly just quit alcohol altogether. Beer is just as bad. Find an obstetrician who will work with you on finding a suitable antidepressant. Just about any of them is safer than alcohol.

You need to talk with some professional to help you get yourself and you infant out of danger.

Please find some one.

Tom Hale, RPh., Ph.D.
Professor