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Citalopram and breastfeeding

Especially over the past year of the pandemic many mothers are asking about the compatibility of citalopram during breastfeeding. It has been a hard time for everyone with the incidence of anxiety and depression continuing to rise. As access to IAPT ( https://www.england.nhs.uk/mental-health/adults/iapt/) may be more difficult the prescription of medication is inevitable. Alternative CBT access may be available on line via and IESO (https://www.iesohealth.com/en-gb)

Citalopram is widely used and we have a high level of experience with it over many years. It is the drug of choice if it has been used by the mother in the past.

Unfortunately many doctors are, in my experience, still recommending that mothers should stop breastfeeding in order to take antidepressants. This may be that they think life would be easier if someone else could help with care of the baby or that the mother may get more sleep. Sadly, this doesnt always happen and the loss of oxytocin may also lower mood further.

There is often an assumption that pressure to breastfeed can lead to depression but in my experience pressure to stop breastfeeding in order to take medication may increase depression and may also stop mothers accessing professional help to avoid having that discussion.

This link to the RCGP perinatal mental health toolkit may be useful for professionals and parents

RCGP perinatal mental health toolkit

This factsheet contains information from my book Breastfeeding and Medication. Please message me for references used or with any questions.

citalopram and breastfeeding factsheet

Breastfeeding and chronic medical conditions contains chapters on anxiety and depression

wendy@breastfeeding-and-medication.co.uk

Hayfever and breastfeeeding

This is the beginning of the hayfever season with the sun coming out so today I recorded the video about the compatibility of drugs to treat symptoms and breastfeeding

I’ve also uploaded the powerpoint which I used to present this that you can share

https://youtu.be/2bsCUFaeMMs

hayfever and breastfeeding powerpoint

https://breastfeeding-and-medication.co.uk/wp-content/uploads/2021/03/hayfever.jpg

List of factsheets available on Breastfeeding and Medication

I have for a long time been intending to compile a list of all the factsheets available on Breastfeeding-and-Medication.co.uk. A miserable, wet day has prompted me to get on with it.

So here is the list :

If you search for any word on the title the factsheet page should appear

List of factsheets Breastfeeding and Medication

If you use them a lot maybe you need the books

Mirtazapine and breastfeeding

One of the newer ways of treating depression is Mirtazapine. It is structurally dissimilar to SSRIs and tricyclic antidepressants. It produces fewer symptoms of sexual dysfunction that have been reported in SSRIs and is particularly useful if insomnia is present as part of the depression picture. We all know of those long nights as you struggle to sleep but your brain wont stop.

The literature on breastfeeding is poor with only 11 breastfeeding mothers in total studied but the poor oral bio-availability together with the studies is reassuring that little passes into milk but as with all centrally acting drugs we should be observing the baby for signs of increased drowsiness or poor feeding

Mirtazapine and breastfeeding factsheet

If you found this useful you might like to consider buying the book from which the information was taken. Please email me with any questions wendy@breastfeeding-and-medication.co.uk

Rosacea and breastfeeding

It is funny how questions come in groups. At the moment many mothers are contacting me with questions about Rosacea particularly wanting to use Soolantra (Ivermectin cream).

This is the chapter from my book Breastfeeding and Chronic Medical Conditions which I hope helps.

The information on ivermectin cream is limited but Hale suggests a relative infant dose of 1.3 even after oral medication, so topical absorption is unlikely to affect a breastfed infant.

I have today (5th March 2021) reduced the price of the paperback and kindle version of Breastfeeding and Chronic Medical Conditions.

Please email me with any questions wendy@breastfeeding-and-medication.co.uk

Rosacea and breastfeeding factsheet

Mirtazapine and breastfeeding

Another medication used during breastfeeding for anxiety and depression is mirtazapine. It may be used where other SSRIs have not been effective or tolerated. Mirtazapine may be also be seen as an option where insomnia is a symptom of  anxiety or depression.

The baby should be observed for signs of drowsiness and ineffective feeding.

Care should be taken with co sleeping because it is likely to cause drowsiness in the lactating mother. Falling asleep in chairs or on sofas should be regarded as an even greater risk https://www.basisonline.org.uk/

LactMed summarises that “Limited information indicates that maternal doses of up to 120 mg daily produce low levels in milk and would not be expected to cause any adverse effects in breastfed infants, especially if the infant is older than 2 months.” In practice the normal dose is 15mg taken at night.

Professionals may find the RCGP Perinatal mental health toolkit a useful resource https://www.rcgp.org.uk/clinical-and-research/resources/toolkits/perinatal-mental-health-toolkit.aspx

The information in this factsheet is taken from my book Breastfeeding and Medication. Please message me with queries or the references used. wendy@breastfeeding-and-medication.co.uk

Mirtazapine and breastfeeding factsheet

Sertraline and breastfeeding

Especially over the past year of the pandemic many mothers are asking about the compatibility of sertraline during breastfeeding. It has been a hard time for everyone with the incidence of anxiety and depression continuing to rise. As access to IAPT and IESO is more difficult the prescription of medication is inevitable.

Sertraline is the first choice medication for breastfeeding mothers as virtually none gets into milk and that we have a high level of experience with it over many years.

Unfortunately many doctors are, in my experience, still recommending that mothers should stop breastfeeding in order to take it. This may be that they think life would be easier if someone else could help with care of the baby or that the mother may get more sleep. Sadly, this doesnt always happen and the loss of oxytocin may also lower mood further.

There is often an assumption that pressure to breastfeed can lead to depression but in my experience pressure to stop breastfeeding in order to take medication may increase depression and may also stop mothers accessing professional help to avoid having that discussion.

This link to the RCGP perinatal mental health toolkit may be useful for professionals and parents

RCGP perinatal mental health toolkit

This factsheet contains information from my book Breastfeeding and Medication. Please message me for references used or with any questions.

Setraline and breastfeeding factsheet

Breastfeeding and chronic medical conditions contains chapters on anxiety and depression

wendy@breastfeeding-and-medication.co.uk

Covid Vaccine and Breastfeeding

I have been inundated with questions about the vaccine against Covid 19 and breastfeeding. Initially the recommendation was that it shouldnt be given until a mother had stopped breastfeeding (which caused consternation in the front line workers who needed it so badly to protect themselves and their families as well as patients ). This was revised by the MHRA and JCI once the first urgency of licensing the vaccines was past.

The information is that either the Pfizer/BioNtech or Astra Zenica/Oxford vaccines can be administered to a breastfeeding mother. I wrote this update for BfN which contains links to all the other information including InfantRisk

However, there are still queries from mothers who have been unsettled by poor information circulating on social media. I hope to allay these fears but ultimately the decision which you make is that which feels right for you.

  1. No there havent been any studies on the transfer through milk to babies but one is currently being undertaken by Imperial College using the milk of mothers before and after vaccination.
  2. It is not possible to interrupt breastfeeding for a period to minimise the transfer of milk. Vaccines do not have a half life like drugs.
  3. We have no reason to believe that the COVID-19 vaccine transfers into milk any more than any other vaccine which we use. What transfers are antibodies which the mother has made. We look forward to hearing whether these offer any protection to the baby. We know that antibodies after the mother has had COVID do transfer and protect.

I hope that this helps to answer some of the frequently asked questions and that all those having the vaccine stay safe and well as they work so hard to protect and treat the rest of us.

Heart emojis meaning: A guide to using the symbols and when to use them
Thank you NHS

https://www.breastfeedingnetwork.org.uk/coronavirus/

Breastfeeding after CT and MRI scans

Virtually every day I get messages from mothers and health visitors querying whether mothers can continue to breastfeed after CT and MRI scans. I was told that the national guidelines had been updated some years ago to align with RANZR guidelines . Sadly this doesnt seem to have been adopted by all radiology departments from my experience.

I was lucky enough to work with Dr Gabrielle Cronin on this paper which was published recently in the Irish BMK https://rb.gy/opvtzx

Most mothers are advised to stop breastfeeding for 24 hours but there is no evidence for this as most contrast media are not orally bio available and have half lives which do not justify this duration.

More information

https://www.breastfeedingnetwork.org.uk/ct/ https://www.breastfeedingnetwork.org.uk/mri/

RANZR guidelines

ADHD and Breastfeeding

I have shared the chapter on ADHD from my book Breastfeeding and Chronic Medical Conditions multiple times this week. Many mothers seem to be diagnosed in later life and are concerned about breastfeeding. Hope this is a useful link.

More information Breastfeeding and ADHD factsheet

If this is useful maybe you need the book available on Amazon. I published on Kindle to try to make this more affordable and available to mothers and breastfeeding supporters as well as professionals