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Another chapter from my book Breastfeeding and Chronic Medical Conditions today on the treatment of migraines which affect so many people. Migraines are miserable, when you have to continue to deal with a baby or toddler or older child and cant go and sleep in darkened room they can break the best. This factsheet goes through some of the treatments for breastfeeding including sumatriptan. Hope it helps. Maybe time to buy the very reasonably priced book available from Amazon ? https://www.amazon.co.uk/Breastfeeding-Chronic-Medical-Conditions-Wendy/dp/B08HTG6LBK/ref=sr_1_1?dchild=1&keywords=breastfeeding+and+chronic+medical&qid=1622820951&sr=8-1
I am very proud to support all the breastmilk banks in the UK who provide milk to mothers of neonates. I was intensely grateful just over a year ago when my youngest grand daughter was born early, weighing just 3 and a half pounds. My daughter had fed 2 other children and like me is passionate about exclusive breastfeeding. However, she was exhausted trying to pump and stimulate her supply for our little wee scrap to keep her blood sugars up. She was given the gift of a small volume of donated breastmilk which took the pressure off for a few hours to allow her to sleep. Of course this was all during the height of the pandemic and she was seperated from her husband and children. She described it this way: ” It was if the donor mums were holding both of us safe, they were feeding my baby for just a few hours whilst I regained my strength. I can never thank those mums enough for that relatively small amount of milk (24ml), which was worth so, so much to me. By the following morning I had enough milk to provide the supplements through the NG tube“
Milk from donating mothers has to be free of medication which might affect the health of the tiny, vulnerable pre-term. I have drawn up this list but it seems to change regularly . Thank you to every mum who makes the precious donation of breastmilk
In the final of the sheets on antidepressant / anti anxiety SSRIs is fluoxetine. It is often looked on as the least compatible with breastfeeding because of its long half life and greater passage into milk. However, it is often used in pregnancy because there are a significant number of studies https://www.medicinesinpregnancy.org/Medicine–pregnancy/Fluoxetine/. What is perhaps less well known is that if a mother has taken it throughout pregnancy the baby MAY be very drowsy in the first few days after delivery as it withdraws from the higher levels achieved through placental transfer.
My recommendation for any mother taking fluoxetine during pregnancy and wishing to breastfeed is to learn hand expression in preparation https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/breastfeeding-resources/hand-expression-video/ and to maybe discuss antenatal expression of colostrum with the midwife, just in case the baby is sleepy and taking time to latch effectively. Colostrum can raise blood sugars in very small amounts. (This is really helpful info for the red flags of low sugar and in my opinion explains everything well https://www.guysandstthomas.nhs.uk/resources/patient-information/maternity/protecting-your-baby-from-low-blood-glucose.pdf)
So you can breastfeed after delivery if you have taken fluoxetine but you may need a little help and support. Seek this antenatally so you are well prepared.
I would also add that if fluoxetine has been the SSRI that you have used and found effective in the past, then that would make it the first choice in breastfeeding. Some babies are colicky, some are drowsy, some vomit, some have loose diarrhoea – but we cant tell in advance.
I remember the very first study I looked at on fluoxetine some 25 or more years ago that the mother and the baby’s paediatrician thought the baby hadnt changed behaviour when exposed to fluoxetine via his mother’s breastmilk. The baby’s father (also a paediatrician) perceived it as more irritable and on that anecdotal basis back then it was said that fluoxetine made babies irritable. I cant find the report any more but if we had been able to see into the family unit we may have seen a dad trying to help his partner whilst working and feeling stressed himself. Who knows?
I hope this information is useful to anyone taking fluoxetine whilst breastfeeding
A question which is coming up very frequently just now is the use of cyclogest pessaries in pregnacy for mums who are still,breastfeeding. So to save me keep typing ( and to help you, of course) here is the information.
Sadly the incidence of post natal depression and anxiety has increased and even doubled during the pandemic http://New mothers twice as likely to have post-natal depression in lockdown and we know that many find it hard to go to see their doctor or fear that they will be told to stop breastfeeding to take medication. Some prefer a more natural, herbal remedy and will purchase St John’s Wort. This is the information on the compatibility of hypericum with breastfeeding. If you want to discuss your medication and suitability please email me on firstname.lastname@example.org .
I’m really saddened that so many mothers are recommended to stop breastfeeding in order to be treated with medication. There is some evidence that breastfeeding in itself protects the mother
I hope that this factsheet provides some alternatives. The information is taken from Breastfeeding and Chronic Medical Conditions – price reduced so worth buying a copy on Amazon
So many people now seem to have regular migraines which are debilitating and make life with babies and children a nightmare.
Preventive treatment may be appropriate if the mother suffers at least two attacks a month, an increasing frequency of headaches, suffers significant disability despite suitable treatment for migraine attacks or cannot take suitable treatment for migraine attacks.
- Beta-blockers e.g., propranolol are effective.
- Tricyclic antidepressants e.g., amitriptyline
all of which are safe in breastfeeding. More information in the factsheet
References are available by emailing me email@example.com or can be found in Breastfeeding and Medication
I am not going to pretend that I am an expert on complimentary medicine but I am frequently asked about Agnus Castus for fertility and menstrual issues so am including this information based on the LactMed entry
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
This factsheet contains information from my book Breastfeeding and Medication. Please message me for references used or with any questions.
Breastfeeding and chronic medical conditions contains chapters on anxiety and depression
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