Just a note of caution on Effexor: it is known among the patient
community as "side-effexor" for the many troubling side effects it
seems to cause, particularly when you are trying to get off it.  As a
veteran of a three-month siege of unpleasant withdrawal symptoms,
I am particularly wary of this drug.  If someone is going to use it, I'd
make sure she got the extended release version, as this avoids the
daily withdrawal symptoms as blood levels head down.

There are other ADs out there to consider as well, which the
psychiatrist must surely know about.  For example, Celexa is new in
the US, but has been used in Europe for several years.  There are
two studies published that support it having a good profile w/r/t milk
transfer.

As far as using Ritalin as an adjunct to anti-depressant therapy, the
use of stimulants is pretty standard now.  Another possible option is
using Cytomel (T3 thyroid hormone), or Cytomel and Synthroid (T4).

Speaking only in my role as a chemical experiment subject,
Rachael Hamlet

On 10 Nov 99, at 10:14, Dr. Tom Hale wrote:

> To : Jennifer
> Re : Prozac
>
> First, while I think the literature supports the use of Zoloft over
> Prozac, it is quite well known that some patients simply don't respond
> to some SSRIs (serotonin reuptake inhibitors) like they do others.  So
> often physicians have to switch between these drugs to find one that
> the patient  likes and does best on.
>
> While I am uncomfortable with the use of Prozac in the neonatal
> period,  a 10 month old infant should do just fine with exposure to
> Prozac.  I would suggest the lowest possible dose, say 20 mg, but even
> 40 is probably alright with this infant.
>
> As for the Ritalin,  I've never heard of adding this to an
> 'activating' SSRI before, but I would defer to this psychiatrist's
> experience on this subject..   I suppose that if the mom did not
> breastfeed the infant for 5-8 hours after taking the med, then the
> infants exposure would be lessened.  However, I would still observe
> this infant closely for hyperactivity, insomnia, and anorexia.  At the
> first sign of any of these, then I would question the use of Ritalin.
>
> I do have another suggestion.  The SSRI  Effexor, acts much like the
> other ones, but also has an 'activating component' that stimulates
> norepinephrine and serotonin, both.  This would mimic the Ritalin
> effect to some degree.  We have one paper on Effexor, and the milk
> levels were moderate to low, with no effect on the breastfed infants.
> Perhaps the patients' doctor might try Effexor instead of the Prozac+
> Ritalin mixture to see if it would help this mom.
>
> Regars
>
> Tom Hale, PH.D.
> Associate Professor of Pediatrics
>

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