Selective Serotonin Reuptake Inhibitors (SSRIs) for Postpartum Depression
How It Works
SSRIs improve your mood by increasing your brain's use of a chemical messenger (neurotransmitter) called serotonin. You may start to feel better within 1 to 3 weeks of taking antidepressant medicine. But it can take as many as 6 to 8 weeks to see more improvement. If you have questions or concerns about your medicines, or if you do not notice any improvement by 3 weeks, talk to your doctor.
Why It Is Used
How Well It Works
SSRIs have become the first line of treatment for depression, because they have proved effective for most people and have few side effects.2
Maternal side effects of SSRIs, which tend to improve over time, can include:
Breast-feeding infant side effects
Breast-feeding babies whose mothers take an antidepressant often do not have side effects. But they may. If you are taking an antidepressant while you are breast-feeding, talk to your doctor and your baby's doctor about what types of side effects to look for.
Experts cannot yet say that a mother's antidepressant treatment is completely safe for the breast-fed baby. But research does show which SSRIs seem most safe. Sertraline (Zoloft) is typically the first choice for a breast-feeding mother. Side effects have only been seen in some breast-feeding babies exposed to fluoxetine (Prozac, Sarafem), paroxetine (Paxil), or citalopram (Celexa).3, 1 Side effects include poor feeding and more crying and irritability.1
Some SSRIs, such as fluoxetine and citalopram, are passed on to the breast-fed baby more than others. Also, every woman uses (metabolizes) and passes on medicine in different amounts. The level of medicine in your breast milk depends in part on when you take your daily dose. Talk to your doctor about when the level of medicine in your breast milk is lowest.
Researchers are studying children who breast-fed while their mothers took SSRIs. So far, they have seen no signs of problems in these children into their preschool years.4
See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)
FDA Advisories. The U.S. Food and Drug Administration (FDA) has issued:
What To Think About
SSRIs are effective for treatment of PPD. Some experts recommend using an SSRI to prevent PPD in high-risk women. But studies have not yet proved that this works.3
Talk to your doctor about your postpartum depression symptoms, and decide on what type of treatment is right for you. Counseling and support are considered a first-line treatment for mild to severe PPD. Women with mild PPD are likely to benefit from counseling alone. And those with moderate to severe PPD are advised to combine counseling with antidepressant medicine.
SSRIs make bleeding more likely in the upper gastrointestinal tract (stomach and esophagus). Taking SSRIs with NSAIDs (such as Aleve or Advil) makes bleeding even more likely. Taking medicines that control acid in the stomach may help.5
Women who take an SSRI during pregnancy have a slightly higher chance of having a baby with birth defects. But not treating depression can also cause problems during pregnancy and birth. If you become pregnant, you and your doctor must weigh the risks of taking an SSRI against the risks of not treating depression.
Do not suddenly stop taking an SSRI. Abruptly stopping an SSRI medicine can cause headaches, nervousness, anxiety, or insomnia. An SSRI must be gradually tapered off with supervision from your doctor.
SSRIs and breast-feeding
Treating postpartum depression is very important for both you and your baby. Untreated postpartum depression can have bad effects on your baby's development.6
Breast-feeding is also proved to be good for babies and mothers. This is why breast-feeding is recommended for the first year after childbirth.
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