A woman may be diagnosed with anxiety prior to becoming pregnant. Symptoms may also begin to occur during or after pregnancy, during the postpartum phase. Regardless of the specific situation for anxiety symptoms, breastfeeding women may enter a time in which they are considering taking anxiety medications. There are a wide variety of anxiety medications available for prescription. Every person with anxiety will have different symptoms, and these symptoms help to determine the best medication for her treatment. The general categories for treating anxiety include antidepressants, benzodiazepines, buspirone, hydroxyzine, and beta-blockers. Based on guidance from the American Academy of Family Physicians, most doctors will prescribe antidepressants such as selective serotonin reuptake inhibitors (SSRIs) as the first-line treatment for anxiety. SSRIs affect serotonin levels in the brain. These drugs are considered very effective in treating anxiety and they don’t have a misuse potential.

Are Anxiety Medications Safe to Take While Breastfeeding?

Along with SSRIs such as Prozac, Celexa or Lexapro, selective-norepinephrine reuptake inhibitors (SNRIs) are also antidepressants intended to treat anxiety. These can include drugs like Effexor and Cymbalta. Tricyclic antidepressants include Pamelor and Tofranil, among others. Benzodiazepines are sometimes recommended as a short-term anxiety treatment, and they work quickly by causing a sedative effect. Benzodiazepines include drugs like Xanax, Klonopin, and Valium. Benzodiazepines do have misuse potential, and people become addicted to them, so they’re not typically the first choice as an anxiety treatment. Buspirone is a medication sometimes used to treat generalized anxiety disorders. Beta blockers are actually heart medications, but they may be prescribed for panic disorder or various forms of anxiety because they help reduce certain physical symptoms of anxiety.

There is varying information available surrounding the use of anxiety medications while breastfeeding. Some medications are likely to be safer than others. Most importantly, antidepressants should only be taken during breastfeeding under the supervision and direction of your healthcare provider. Zoloft appears to be a safe anxiety medication while breastfeeding. Paxil may also be safe, and Prozac would probably be the last choice among SSRIs for use during breastfeeding. Even with Prozac,  known risks and adverse effects are minimal, and only include instances of colic in infants.

How Can Antidepressants Affect Your Baby?

There seem to be very few adverse effects as a result of taking anxiety medication while breastfeeding. There are different factors that will likely be weighed by your healthcare provider before making a determination. Some of these factors include the known and unknown risks of the specific medication exposure via breast milk, and the effects of anxiety left untreated in a mother. Doctors will also consider the benefits of breastfeeding for the baby. All medications taken by the new mother are believed to pass through breast milk, but the concentration levels differ depending on the specific medication. If a baby is premature, it may be riskier to take antidepressants during breastfeeding because they lack the mature ability to metabolize drugs in the same way as a baby born full term. With babies born preterm, breastfeeding might be advised against if the mother is taking anxiety medications.

With SSRIs and tricyclic antidepressants, it appears that the amount of the drug that passes to a baby is low, and there are rare instances of related complications for these kinds of antidepressants in breast milk. There have been reports of symptoms such as excessive crying, irritability or sleep disturbances when a baby is exposed to anxiety medications through breast milk, but there isn’t necessarily a correlation between the two. Similarly to antidepressants intended to treat anxiety, it seems benzodiazepines have a low risk of causing adverse effects if a baby is exposed to them through breastfeeding. With benzodiazepines, there may be indirect things to consider, however. For example, benzodiazepines can cause sedation, which could be dangerous if a breastfeeding mother is co-sleeping and she may lack awareness or the ability to wake up when taking one of these medications.

Overall, mothers should know that the amount of any anxiety medication an infant is exposed to while breastfeeding is significantly lower than what the baby would have been exposed to in the womb. However, a doctor will likely try to find the lowest possible effective dose for a breastfeeding mother, just to err on the side of caution. Untreated anxiety can be significantly more problematic while a woman is trying to breastfeed and during the postpartum period.

Alternatives to Taking Anxiety Medications While Breastfeeding

If a woman is unsure of whether or not she wants to take anxiety medications while breastfeeding, there are alternative options available. Her doctor may advise that she participate in some form of talk therapy or counseling. An approach like cognitive behavioral therapy can be an effective way to deal with the symptoms of anxiety. There can be other options suggested as a supplement to talk therapy, such as yoga or meditation. Ultimately, it is possible to take a safe anxiety medication while breastfeeding. However, it’s important to have a discussion with your physician prior to starting or stopping any medication. It’s also important to understand that there are risks to untreated anxiety, which also factors into the decision.

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