The relationship between breastfeeding and postpartum depression (PPD) can be complicated. Although breastfeeding has been linked with reduced risks of PPD, it’s not a one-size-fits-all solution. For some mothers, the pressures of breastfeeding can heighten feelings of anxiety or inadequacy.

PPD affects approximately 1 in 7 parents, according to Cleveland Clinic. If you have this common yet often misunderstood condition, you might find that you feel sad or hopeless, have no appetite, are no longer interested in your favorite activities, or have trouble bonding with your baby. PPD doesn’t just affect new moms — fathers, nonbinary parents, and other non-birthing parents, such as adoptive parents, can also have symptoms of PPD.

To learn more about PPD and breastfeeding, MyDepresssionTeam spoke with Amy Eisenberg, a certified perinatal mental health provider and licensed clinical professional counselor. She currently leads pregnancy, postpartum, and loss groups with the organization Beyond the Baby Blues in Evanston, Illinois, and works with new parents in private practice.

Breastfeeding While Treating Postpartum Depression

Eisenberg noted that many new mothers worry that taking antidepressant medications while breastfeeding could affect their baby’s health. Many new moms may avoid exploring PPD treatment options due to the myth that they can’t take medication while breastfeeding. In reality, “a lot of medications are compatible with breastfeeding,” she said.

Although medications can be present in breast milk, research shows a low risk of complications for a breastfed baby. Your baby’s exposure to a drug depends on the dosage, how often you take the medication, and your metabolism.

Every new parent’s situation is different, and you may or may not benefit from taking medications to manage PPD. “Talk to a perinatal psychiatrist to understand the risks and ask all of your questions,” Eisenberg recommended. Your doctor can help you weigh the risks and benefits of these medications so you can make informed decisions about your baby’s health and your own.

When balancing pros and cons, it’s important to remember that a mother’s mental health has a strong impact on their baby’s well-being. If taking medication improves your PPD symptoms, “now you’re able to be present with yourself and the baby,” Eisenberg said.

Below is an overview of safety information for various PPD treatments and breastfeeding.

Selective Serotonin Reuptake Inhibitors

Selective serotonin reuptake inhibitors (SSRIs) such as sertraline (Zoloft) and fluoxetine (Prozac) are often prescribed as first-line (preferred) treatments for PPD. SSRIs are also some of the best-studied medications in breastfeeding mothers and are generally considered safe. Research shows that a very low amount of the medication transfers to breast milk, and negative effects on babies are very rare.

Recent studies have shown that treating PPD with SSRIs is linked with a lower risk of attention-deficit/hyperactivity (ADHD) in children up to age 5. The researchers also noted better mental health outcomes for mothers who received this treatment.

Tricyclic Antidepressants

Tricyclic antidepressants (TCAs) are another PPD treatment option, with nortriptyline (Pamelor) and imipramine (Tofranil) being the most studied in this drug class. Research suggests that babies receive little to no exposure to these medications through breast milk, and complications for infants are rare.

Bupropion

Bupropion (Wellbutrin) may be prescribed for PPD if SSRIs or TCAs aren’t effective. Although research on bupropion use during breastfeeding is limited, one very small study found that the medication was undetectable in infants and showed no apparent side effects. However, more research is needed to determine the drug’s safety for breastfeeding babies.

Zuranolone

Zuranolone (Zurzuvae) is an oral (taken by mouth) drug approved by the U.S. Food and Drug Administration (FDA) in 2023 to treat PPD. Unlike other treatments, zuranolone is taken for just 14 days.

Because zuranolone is a newer medication, there’s less available information about this treatment compared to drugs that have been used for decades to treat PPD. Early research shows that only low levels of zuranolone pass into breast milk, but more studies are needed to understand the potential effects on breastfed babies. The manufacturer advises speaking with your healthcare provider regarding breastfeeding during the two-week treatment period.

Breastfeeding Challenges and Maternal Mental Health

New mothers have varied experiences with breastfeeding. Although some find it brings positive emotions, others may face challenges or negative feelings linked with breastfeeding.

The high expectations of motherhood can sometimes cause feelings of guilt and shame, including around breastfeeding. Difficulties with breastfeeding can affect self-esteem and mental health, especially when there’s pressure from family, healthcare providers, or societal norms.

A 2023 study found that pressure to breastfeed, particularly from healthcare providers, increased depressive symptoms in women, especially during the postpartum period. This pressure, combined with feelings of guilt or shame around breastfeeding, can contribute to PPD or worsen PPD symptoms.

Eisenberg said that some new mothers she sees feel like “they have failed their baby” if breastfeeding doesn’t work for them. “A lot of women have also described that they feel like they’re not maternal enough and that there's something wrong with them,” she said. “There’s a lot of fear that ‘I’m not giving my baby the best.’”

When caring for a mom in this situation, “I want to be completely nonjudgmental,” Eisenberg said. “I really want to reiterate the importance that your baby is fed. ‘Fed is best’ is a really good message for moms.”

In some cases, Eisenberg works with a mother to find ways to continue breastfeeding, often with the guidance of a “nonjudgmental lactation consultant.” Other times, Eisenberg helps a mother make peace with moving on from breastfeeding: “I try to follow the mom. If I see that she’s really questioning [breastfeeding] but the guilt is holding her back, I’m going to support her.

“There might be some guilt that we need to work through, but generally there’s a lot less anxiety, and then they get to enjoy their time with the baby even more,” Eisenberg added.

Breastfeeding’s Positive Effects on Mental Health

Breastfeeding has been shown to provide mental health benefits for both new mothers and their babies, potentially protecting against PPD. The hormones oxytocin and prolactin, which are released during breastfeeding, play a key role in the emotional attachment between mother and baby and can help reduce stress and improve mood.

Oxytocin, which Eisenberg and others call “the love chemical,” strengthens the bond between mother and baby and promotes relaxation, which may ward off the sad feelings that can come with PPD. Prolactin primarily regulates milk supply, but this hormone is also associated with contentment, relaxation, and attentiveness.

Beyond the hormones’ effects, establishing a structured breastfeeding routine can offer a sense of predictability and stability, which may help manage PPD. “If [breastfeeding] works, it can be very healing,” Eisenberg said. “It can be a really good way to increase attachment between mom and baby.”

Benefits of Lactation Support

A lactation consultant is a healthcare professional who provides support, guidance, and reassurance to breastfeeding mothers. For those facing challenges or complicated feelings about breastfeeding, working with someone who can address both emotional and physical needs is especially important. Eisenberg noted that she prefers referring people to lactation consultants she trusts to be nonjudgmental, ensuring they won’t pressure mothers.

Talk to your healthcare provider or a mental health professional about finding a lactation consultant in your area.

Find Your Team

MyDepressionTeam is the social network for people living with all types of depression, including postpartum depression, and their loved ones. Members come together to ask questions, offer support and advice, and share their stories with others who understand life with PPD.

Did you know about the risk factors for postpartum depression before your baby was born? Do you have any advice for others managing these risks? Share your experience, or start a conversation by posting on your Activities page.