Zoloft has been the most popular antidepressant medication used by new mothers because of studies that show lower concentration of Zoloft in the breast milk. But moms committed to breastfeeding are often skeptical about taking any kind of drug not supported with long-term studies.
This website offers extensive information about therapies that can help you fight postpartum depression. You should explore those options even if you begin treatment with Zoloft or other anti-depressant medications. A huge misconception is that we choose either a medication approach or a “natural” approach ala Tom Cruise. Depression is such a complicated disease that we really need to create a treatment strategy that works for us; there are no one-size-fits-all treatment plans. I strongly encourage you to read more about postpartum depression on this website.
Zoloft and Breastfeeding: No One-Size-Fits-All Answer
A friend of mine called to tell me she was starting Zoloft and breastfeeding. She sounded sheepish because she knew I did not take anti-depressant medications in my first pregnancy. I spent over two years in deep cycles of depression and had several instances of psychosis and never took prescription medication. I know that many people think that getting by for over two years makes them strong, but I consider myself lucky that I did not harm myself or my baby. I needed help and I floundered. My friend, on the other hand, was working with a medical professional and trying a medication. I wished her luck and I hoped she would do well. She did do well and I am pleased that she found a solution. She is a Zoloft and breastfeeding success story. I directed her to my information on Omega 3 and depression and foods for depression because many of those nutrients improve your depression above and beyond the possible improvement of a prescription medication.
Not everyone responds well to Zoloft which is why it is critical to you to keep working with your doctor so that you can find something effective for you. In my second pregnancy, after I had developed this website and written the Rebuild from Depression book, I described survival tools that I used. I encourage you to follow that story and pick and choose what might be best for you. (Read it here.)
Peak Concentrations of Zoloft and Breastfeeding at Low Concentrations
Back when I was considering using Zoloft while breastfeeding, I investigated breastfeeding strategies that would help me reduce baby’s exposure to Zoloft. You might consider doing the same, but if this strategy adds to your stress and obsession, it is probably best not to worry about Zoloft concentrations in your milk.
In developing your strategy, understand first that when you take your daily dose of Zoloft, it will enter your bloodstream, the levels will gradually build, and then the levels will decline. What you want to do is try to get baby’s feeding schedule to line up with the low concentrations of Zoloft in your blood.
According to a study in the 1997 American Journal of Psychiatry, Zoloft will peak in your milk at 7-10 hours after your dose.
If you are lucky enough to have a baby who sleeps through the night, you could take your dose about two hours before bedtime (or even at bedtime) and let baby sleep through those peak concentrations of Zoloft. Ideally you would begin breastfeeding about 14 hours after the dose.
That is a very long time, but look at the actual study on Zoloft and breastfeeding. Note Figure 2 on page 1258. Not breastfeeding during 4-12 hours after your dose is your next best strategy.
Zoloft and Breastfeeding with Non-Sleepers
I am well aware that there are many babies who don’t sleep for more than a couple of hours. I have many hours of sleep loss to prove it.
If that’s the case, you’ll be nursing in the 7-10 hour peak time and in the 4-12 hour range. One way to manage this situation if you want to reduce baby’s exposure is to keep these breastfeeding sessions short. During peak concentration, have short nursing sessions where baby primary gets fore milk.
There are higher concentrations of the medication in the hind milk.
The hind milk is the milk that our bodies produce several minutes into the nursing session. The first milk that comes out is more watery, the low fat version of human milk. The hind milk is the whole milk. If baby is loaded up with milk during lower concentration periods, baby might be content with a short nursing session and a little fore milk at peak hours.
–>Scheduling my baby is going to drive me crazy
I know. It might be better to forget all of this information and peal concentrations of Zoloft and breastfeeding. But for people who are interested, I have provided it. Not all moms and all babies fit into the schedule that this research suggests.
Zoloft and Breastfeeding: Quit Breastfeeding?
Don’t entertain the question. Just because this article suggests reducing baby’s exposure to Zoloft while breastfeeding, the most important thing for baby is to receive your milk. Your milk has the nutrients your growing baby needs and you are providing immunities to disease to that young person. The reason Zoloft is so often recommended for breastfeeding mothers is that only trace amounts of the medication make it into the milk. Forge ahead!
Beyond Zoloft and Breastfeeding: Improving My Depression
If you are struggling with depression, consider your nutrient status. Improving your nutrient status will alleviate your depression. Depending on other circumstances in your life, nutrient therapy may take care of your depression in pregnancy altogether.
Look at your Omega-3 fatty acid and B-vitamin intake. These deficiencies are common. Our need for Omega-3s and B-vitamins is higher in the third trimester of pregnancy and during breastfeeding than at any time in our lives. Read my Omega 3 for depression article.
Have your doctor check your iron. You may need to take a prenatal vitamin with iron, but you should also increase the iron in your diet. The iron rich foods website is an excellent place to start.
On your good days, check out my “Good Days Strategies” approach — it’s an online discussion about leveraging your good days so that you will have fewer bad days. Read more about my Good Days Strategies here.
Best of luck to you on your breastfeeding and Zoloft quest.