Dear Shari,
I just got back from a conference where Dr Hale spoke on just this subject in
Chesapeake, VA.  Prozac is the only antidepressant approved for pregnancy and
it has a long half life so after a person quits taking it, there will be a
gradual decline in her blood for 2 to 3 weeks, which pervents the mom from
"crashing" and gives her time to switch drugs if that is planned.  Some
recommend that it be stopped about a month before the due date so that this
gradual weaning can occur in mom and baby, then the mom can be switched to a
drug that is safer in breastfeeding.  Zoloft is the first choice in
breastfeeding because of being so highly protein bound that it is often
undetectable in the baby. Now Zoloft does not have the same long effect after
stopping it, so patients should be weaned slowly when stopping it or they may
experience severe depression/symptoms from the withdrawl.  Paxil is the 2nd
choice.  Of course the mother has to have a drug that will work for her and
the doctors know there is no way to tell exactly which drug will work for
which patient.  They just try and find one that relieves the symptoms.  So if
the mother has never tried Zoloft or Paxil, it may be worth a try.
Personally, I have had 5 to 10 mothers in the last year on Zoloft and Paxil
who are nursing happily and babies are fine.
Get Dr. Hale's book and consult his web site, look in Lactnet archives and
get all this info to the mom and her doctor.
http://neonatal.ttuhsc.edu/lact/

Jane Bradshaw RN, BSN, IBCLC
Hospital and private practice
Lynchburg, VA
LLLL for 20 years

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