What are the treatment options for acute anxiety postpartum in a breastfeeding mother?

From the Guidelines

For acute anxiety postpartum while breastfeeding, first-line treatment options include selective serotonin reuptake inhibitors (SSRIs) such as sertraline or escitalopram, which are generally considered safe during breastfeeding with minimal infant exposure. These medications can be used to regulate neurotransmitters like serotonin, addressing the biological aspects of anxiety.

Treatment Options

• Selective serotonin reuptake inhibitors (SSRIs) like sertraline (starting at 25-50mg daily, gradually increasing to 50-200mg daily) or escitalopram (5-10mg daily) are recommended as first-line treatment options 1.
• Cognitive behavioral therapy (CBT) is also highly effective and can be used alone or in combination with medication, providing coping strategies for the psychological components of anxiety.
• For immediate symptom relief, short-term use of benzodiazepines like lorazepam (0.5-1mg as needed) may be considered, though these should be used cautiously and briefly due to sedation risks.

Non-Pharmacological Approaches

• Prioritize sleep by sleeping when the baby sleeps.
• Accept help from family and friends.
• Practice relaxation techniques like deep breathing or meditation for 10-15 minutes daily.
• Join a postpartum support group.
• Maintain gentle physical activity like walking with the baby for 20-30 minutes daily. Regular follow-up with healthcare providers is essential to monitor both maternal symptoms and infant wellbeing, as noted in studies on the management of depression and anxiety 1.

From the FDA Drug Label

are breast-feeding or plan to breast-feed. Some sertraline may pass into your breast milk. Talk to your healthcare provider about the best way to feed your baby while taking sertraline. Nursing MothersBecause Prozac is excreted in human milk, nursing while on Prozac is not recommended.

Treatment for acute anxiety postpartum while breastfeeding is not directly addressed in the provided drug labels. However, the labels mention that sertraline and fluoxetine can pass into breast milk.

• For sertraline, it is recommended to talk to a healthcare provider about the best way to feed the baby while taking the medication 2.
• For fluoxetine, nursing while on the medication is not recommended 3. No conclusion can be drawn regarding the treatment of acute anxiety postpartum while breastfeeding.

From the Research

Treatment for Acute Anxiety Postpartum while Breastfeeding

• The treatment for acute anxiety postpartum while breastfeeding can be managed with certain medications, such as selective serotonin re-uptake inhibitors (SSRIs) 4.
• Sertraline is considered one of the safest antidepressants during breastfeeding, and women already taking sertraline should be advised to breastfeed and continue the medication, starting with low doses and slowly increasing the dose with careful monitoring of the newborn for adverse effects 5.
• The literature shows that paroxetine and fluoxetine have the strongest association with negative outcomes, while the associations between sertraline and citalopram with negative outcomes remain mixed and generally unsubstantiated when studies that show an association are controlled for the effects of maternal depression and associated factors 4.
• Sertraline and citalopram should be first-line drug treatments for anxiety and depression in pregnant women in the SSRI class, and sertraline can be continued in breast-feeding as the concentration found in breast milk is very low and has not been linked to infant complications 4.

Breastfeeding and Anxiety

• Postpartum anxiety may be associated with reduced breast-feeding confidence and lactation performance, and awareness of this association may be helpful in identifying women at risk for lactation failure and targeting efforts to promote breast-feeding 6.
• High-anxiety mothers are less likely to practice full, exclusive breast-feeding and more likely to have terminated breastfeeding at 1 month, highlighting the need for support and guidance for mothers with anxiety 6.

Clinical Guidelines

• The American College of Obstetricians and Gynecologists (ACOG) has developed a clinical practice guideline for the treatment and management of mental health conditions during pregnancy and postpartum, including recommendations on psychopharmacotherapy for anxiety and depression 7.
• The guideline includes recommendations on the safety and efficacy of psychiatric medications during pregnancy and lactation, and provides guidance on the management of mental health conditions during the perinatal period 7.