Pregnancy, Breastfeeding, & Medication

This post is inspired by #medsandmotherhood week at STIGMAMA.COM, most specifically, this article:

Pump and Dump, by Walker Karraa, PhD #medsandmotherhood.

Before becoming pregnant with my son, I thoroughly surveyed the medical research about antidepressant use in pregnancy and during lactation. Since I had a history of severe depression and suicidal ideation dating back to my late adolescence, I did not want the risk of experiencing depression during pregnancy. My review of scientific literature revealed that the antidepressant Zoloft (sertraline), a selective serotonin reuptake inhibitor (SSRI), had an extremely low serum level in breast milk and an almost immeasurably low serum level in breast-feeding infants themselves. Armed with this knowledge and with my doctor’s blessing, I took Zoloft when I was pregnant and nursed my son. At the time, I received no negative feedback from health care providers, but I did get questions from extended family members, “Is it OK to breastfeed him so long when you are taking medicine?”

The kid loved breastfeeding. He fed for 27 months until it became clear that I was experiencing symptoms of hypomania and that I had bipolar disorder. To treat the manic symptoms, my doctor prescribed Depakote (divalproex sodium), an anticonvulsant commonly used as a mood stabilizer. According to WebMD:

This medication [Depakote] is not recommended for use during pregnancy. It may harm an unborn baby.

This medication passes into breast milk. While there have been no reports of harm to nursing infants, consult your doctor before breast-feeding.

Since Depakote passes through breast milk, we agreed it was time to wean him. By this time my son was a whopping 27 months old, and I was FED UP with waiting for him to “naturally” wean. Upon being prescribed Depakote, I left my son with my husband for the weekend for cold turkey weaning while I went to my parents.

My son couldn’t believe mommy wasn’t coming back home for the night. She had never left him overnight. Though it was raining, he insisted on sitting at the driveway waiting for me to return, then my husband convinced him to sit under the walkway for cover from the rain, then sit in the front doorway, then at the foot of the stairs, then at the top of the stairs, then finally in the master bed with daddy looking downstairs at the front door, until he finally fell asleep. Later, when I told this story to my psychotherapist, she found the story touching and indicative of how sensitive and caring my husband was and still is.

Years later I told my internist the story of my difficulties weaning my son and she laughed and said, “He (my son) just wanted his meds.” I countered that Zoloft has an extremely low serum level in breast milk. She responded, “Yes, but they (newborns) are so tiny.” She was teasing me years after the fact, and she’s an internist, not pediatrician or psychiatrist. Luckily I have a good rapport with my internist. She knows that I’m knowledgeable and confident. It had been over a decade since I nursed my son. She was joking that my son did not want to stop nursing because he wanted his “fix”. Certainly, such as statement could have devastated a less confident mother.

Still I have questioned whether using Zoloft affected my son developmentally, behaviorally, and neurologically, but his psychiatrists dismiss my concerns for guilt and conjecture is not helpful nor healing. I have always tried to do what was in my son’s best interest. My son has struggled with horrible migraines since he was a toddler. He is a very stimulus sensitive individual. But given genetic history of neurologic and psychiatric issues, he’s doing remarkably well. My son is a wonderful and much-loved young man. I am very, very proud of him.