From the Guidelines
Breastfeeding can be psychiatrically destabilizing for some women, particularly those with a history of mood disorders or experiencing high levels of stress and anxiety during the postpartum period. This occurs primarily through several mechanisms, including hormonal fluctuations, physical demands of breastfeeding, and stress of breastfeeding challenges. The hormonal fluctuations that occur during breastfeeding, particularly the rise and fall of oxytocin and prolactin, can affect mood regulation in vulnerable individuals 1. Additionally, the physical demands of breastfeeding, including sleep disruption, can exacerbate existing psychiatric conditions or trigger new ones. Women with a history of mood disorders, particularly bipolar disorder or postpartum depression, may be at higher risk for psychiatric destabilization during breastfeeding.
Some studies suggest that maternal psychosocial distress may influence the immune properties of human milk, with some finding an inverse association between maternal distress and milk concentration of secretory IgA and lactoferrin 1. However, other studies have found conflicting results, highlighting the need for larger studies with long-term follow-up to further investigate the potential influence of maternal mental health factors on breast milk immunoglobulins.
The stress of breastfeeding challenges, such as pain, supply issues, and latching difficulties, can also contribute to anxiety and depression. Furthermore, some women may need to discontinue psychiatric medications during breastfeeding, which can lead to relapse of their condition. For women experiencing psychiatric symptoms while breastfeeding, it's essential to consult with both a mental health provider and lactation specialist. Many psychiatric medications are compatible with breastfeeding, including certain SSRIs like sertraline (50-150mg daily) and paroxetine (20-40mg daily), which have minimal transfer into breast milk 1.
Key factors to consider when assessing the risk of psychiatric destabilization in breastfeeding women include:
- History of mood disorders, particularly bipolar disorder or postpartum depression
- Levels of stress and anxiety during the postpartum period
- Physical demands of breastfeeding, including sleep disruption
- Breastfeeding challenges, such as pain, supply issues, and latching difficulties
- Need to discontinue psychiatric medications during breastfeeding
In terms of management, a balanced approach that considers both the benefits of breastfeeding for the infant and the mother's mental health needs is crucial. This may involve collaborating with a mental health provider and lactation specialist to develop a personalized plan that supports the mother's mental health while also promoting a positive breastfeeding experience.
From the Research
Breastfeeding and Psychiatric Destabilization
- Breastfeeding can have both positive and negative effects on maternal mental health, with some studies suggesting that it may be associated with improved mental health outcomes, while others found that challenges or a discordance between breastfeeding expectations and actual experience can lead to negative mental health outcomes 2.
- Women with severe mental illness (SMI) may face unique challenges when it comes to breastfeeding, including contradictory and insufficient advice relating to breastfeeding and psychotropic medication, which can lead to feelings of being unsupported and may result in stopping breastfeeding earlier than planned 3.
- The use of psychotropic medication during breastfeeding can be complex, and clinicians need to be prepared to manage the breastfeeding woman who needs psychotropics, taking into account the degree of drug passage to the infant and the subsequent effects of this exposure on infant growth and development 4.
Factors Associated with Breastfeeding and Psychiatric Destabilization
- Factors associated with breastfeeding in women with SMI include infant feeding intentions, employment, and non-Caucasian ethnicity 3.
- Breastfeeding challenges, such as inconsistent information about medication and breastfeeding, can be associated with a higher risk of negative mental health symptoms 2.
- The use of certain psychotropic medications, such as lithium, carbamazepine, and valproic acid, may be considered relatively safe during breastfeeding, while others, such as clozapine and amisulpiride, are contraindicated 5.
Non-Pharmacological Treatment Options
- Non-pharmacological treatment options, such as psychotherapy and other non-drug therapies, may be preferred by women with psychiatric disorders during pregnancy and breastfeeding, and can be effective in reducing depressive symptoms and anxiety disorders 6.
- Treatment by telephone and internet, as well as non-invasive brain stimulation procedures, may also be effective and can be particularly useful for breastfeeding women who may have limited flexibility 6.