Why I Decided to Medicate During My Postpartum

I had one week where I slept so little I thought I was going to end up in a psychiatric hospital.

Our scorching takes and astounding insights are free this week. You can help support us by forwarding this email to any like minded lactivist, crunchy mom, homeschooling weirdo, lady beekeeper, or fire breathing matriarch. We’re thrilled you’re here.

My main problem postpartum was I couldn't sleep.

For the most part, my daughter slept fine but I had so much anxiety around sleep that I could not stop my racing thoughts each night:

When will she wake up again?

Should I sleep train?

What will happen when I’m asleep?

What if I NEVER SLEEP AGAIN?

She would sleep soundly and I would just lay stock still next to her all night with my thoughts looping frantically around my head. Then I would cry all day because I loved my baby and I wanted to enjoy her but I couldn't because I was so exhausted and miserable.

I had one week where I slept so little I thought I was going to end up in a psychiatric hospital. 

I was also so scared to take medication. I was terrified of the effects it could have on my daughter's brain. I literally had anxiety about having anxiety. 

I thought the sleep deprivation was the CAUSE of my anxiety and depression (I'm sure it did increase it) but never considered the opposite: crippling anxiety was preventing me from sleeping.

The MOST devastating thought to me was that I would have to give up breastfeeding, which I adored, because I needed to sleep more. Once I had those thoughts I knew I had to get help .

Welcome to my night brain!

I sought help from a perinatal mental health specialist (not covered by insurance) and she helped me formulate a plan to help prioritize sleep (while continuing to breastfeed) and then get supportive medication. 

When it comes to choosing to go on ANY medications or even herbal remedies while breastfeeding, you need to consider benefit/risk. 

There is always risks with any medications. There are also benefits. There are risks of you not going on medications. Are the risks of you not medicating bigger than the risks of medicating? 

For me the answer was YES. If you're a "evidence and research" person, you can find lots of it on the safety of SSRIs like Zoloft (what I take) and breastfeeding and not really any super concerning results. 

There is also plenty of evidence on the effects of a mother having anxiety and depression on a baby. So you must weigh that against the risks of taking medication. 

Most anti-depressants are going to fall into the L2 category, which means "probably compatible" and there have been some studies without any evidence of adverse reactions in babies. 

Benzodiazapines  generally fall into the L3 which also means probably compatible but that there haven't been enough studies and you should only use the medication if the benefit outweighs the risk. 

However, more research is coming out showing that the concentrations of these drugs in the milk are very low, and not a lot of adverse events occur. So it's really up to you and your doctor to determine whether these medications have benefits that outweigh the risks. 

Doctors may tell you that you absolutely cannot use these medications while breastfeeding, especially benzos mostly because of liability. If you look on the inserts of any drug you get from the pharmacy it always says "ask your doctor". That is the same info the doctor uses to determine whether or not he should tell you it's safe. 

The lactation risk categories were developed by Dr. Thomas Hale and he has a lab which studies the concentrations of these substances in breast milk and the reactions that the babies have after. It's also worth noting that just because a certain substance is "transferred in breast milk" doesn't mean that your baby is going to be affected by it. 

For me just knowing these medications were available was enough to relax me enough to sleep. And once I did finally get on a regular SSRI my mind quieted so I could get some sleep. I think it's important to not make breastfeeding or sleep itself a scapegoat as a "cause" of anxiety. Literally your mind can convince you of anything when you're deep in the throes of depression. 

If you're still reading, thank you! This was personal for me. It's not medical advice but I do like to share my story in hopes it helps others. Feel free to reach out if you have any specific questions or want to share your story.