Pregnancy, Breastfeeding, & Medication

Sertraline 25 Mg Oral Tablet by zrrdavatz, on Flickr
Sertraline 25 Mg Oral Tablet by zrrdavatz, on Flickr

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.


10 responses to “Pregnancy, Breastfeeding, & Medication”

  1. […] Pregnancy, Breastfeeding, & Medication […]

  2. From the research I read in the past and current research I reviewed when I writing this post, Zoloft is a safe drug to take during pregnancy and lactation. Maternal depression puts your pregnancy at risk. Obviously, if a woman is severely depressed, she is less likely to take good care of herself and thereby her pregnancy, so it is important to treat depression. Untreated maternal depression is linked to low birth weights and preterm labor. Please do pay attention when you are pregnant to mood or energy changes, as many women find the hormonal changes of pregnancy have affect their moods. Have your partner pay attention to changes to your moods and energy level, for sometimes we overlook those changes in ourselves. It helps to listen to our closest observers. Communicate any changes to your health care provider (psychiatrist?). Good luck! I’ll cross my fingers (praying) that you’ll be receiving good news (of conception) in the near future.

  3. This is a great read! I too am on Zoloft and would like to try and conceive in the near future. I have also been researching the effects on pregnancy and nursing. I think you made great decisions and prove you are a brave and wonderful mother

  4. Pregnancy and breastfeeding definitely can complicate matters. Heck, mental illness itself makes parenting more challenging, or so I imagine, for I only really know what it is like for me to parent my child with my husband.

  5. Interesting things to consider.

  6. What sticks out to me most in this story is that you and your husband are both incredibly caring parents, keeping your son’s best interest in mind.

  7. Thank you, too!

  8. I find it fascinating how unique our bodies’ biochemistries are.

  9. And well you should be proud of your son and yourself as well!! You and your husband sound like terrific parents! It is a win win situation.
    P.S. You are lucky you can take Depakote. I can’t tolerate any mood stabilizer.

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