SSRI Use While Breastfeeding

Postpartum mood and anxiety disorders are very common and occur in 1 in 5 women in the first year postpartum. PMADs can seriously impact a parent’s relationships, quality of life, career, physical health, and ability to care for and bond with the new baby. Some parents never experience mental health challenges until pregnancy, but many had prior concerns that were exacerbated by the hormonal shifts, sleepless nights, and new responsibilities as a new parent.

The most common medication prescribed for PMADs are SSRIs, aka Selective Serotonin Reuptake Inhibitors which help to improve mood by increasing the amount of available serotonin in the brain.

Most SSRIs are considered safe for breastfeeding, especially as the risks of untreated anxiety and depression can be much more dangerous than any effect of the medication in breast milk. Sertraline (Zoloft) and Paroxetine (Paxil) are usually recommended first as they have the most studies showing safety and transfer the least of all SSRIs into breast milk. However, this does not mean that other SSRIs are not safe, they just may not have as many studies proving their safety.

Fluoxetine (Prozac) is considered one of the least preferred SSRIs for breastfeeding due to higher levels reaching the milk. However, if a parent was on Prozac with good results in the past and is now in a mental health crisis, many providers will recommend to resume use instead of experimenting with others because of the risk of not treating the mood disorder. Despite being the least preferred SSRIs, Prozac use is not a contraindication to breastfeeding. Instead, monitor for any adverse reactions in your infant like irritability or disrupted sleep. Extra caution may be warranted for Bupronion (Wellbutrin) due to possible links to seizures, however the research is not clear on if the seizures were caused by the medication.

If you are concerned for your mental health while postpartum, please also see the following resources:
❤️ Postpartum Support International: Call 1-800-944-4773 or text 971-203-7773
❤️ National Maternal Health Hotline: Call or text 1-833-943-5746

Sources:

https://www.ncbi.nlm.nih.gov/books/NBK519070/

https://womensmentalhealth.org/specialty-clinics/breastfeeding-and-psychiatric-medication-2/

https://infantrisk.com/antidepressant-use-during-pregnancy-and-breastfeeding

https://infantrisk.com/content/antidepressant-use-while-breastfeeding-what-should-i-know