I was concerned to read the post yesterday that suggested a mother
might be weaned off her antidepressant medication so that she can
relactate.  I am assuming that the intention was to send the mother
back to her doctor to discuss it, but unfortunately that was not the
way it read.  We need to be careful how we write these things.

As IBCLCs we have no mandate to tell a mother to use, or cease
using, a medication.  Anyone not sure of the limits of the LC role
should read ILCA's excellent new Standards of Practice.  Of course,
doctors who are IBCLCs can prescribe, but that is with their medical
hat on.

Sorry to be preaching, but the post in all innocence hit two raw
nerves for me.  One was some bad PR the IBCLC credential got in
medical circles over an allegation that someone was prescribing
medication (when in fact she wasn't).  We don't need those kinds of
rumours.   The other was when a breastfeeding mother I know had to
drive her car head-on into a brick wall before anyone recognised that
she was depressed (baby was unhurt, mother was in hospital for
months, breastfeeding was abandoned).  I have learnt that you can't
be too careful when a mother is depressed, as it can be hard to judge
the degree of depression and even the suicide risk.

Unfortunately, oxytocin, prolactin and the loving act of
breastfeeding are not enough to prevent or cure clinical depression.
Fortunately, there are a number of antidepressants compatable with
breastfeeding, the mother needs to find a supportive doctor and/or go
armed with good information and a determination to breastfeed.

I have helped two very depressed mothers to relactate, on the
condition they discuss their emotional state with their doctors
first.  Both were put on antidepressants compatable with
breastfeeding and also had their thyroid function checked (low milk
supply, low energy and low mood can be low thyroid).  Relactation is
not easy at the best of times and they needed heaps of emotional
support, but both got back a full milk supply and enhanced bonding.

Thanks for the chance to get this off my chest.
Ros Escott.   Tasmania, Australia