01.14.22 5 min read

Guidelines on Psychiatric Medications to Support Your Breastfeeding Clients

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Postpartum depression is one of the most common complications after birth. About 10-20% of moms are diagnosed with postpartum depression (PPD) in the first year after birth (1).  Postpartum anxiety is less well-studied, but known to be prevalent during pregnancy and postpartum: research suggests up to 10% of women are diagnosed with an anxiety disorder in the months after birth (2), but actual numbers are likely higher. Anxiety and depression often are experienced together during the postpartum period (3).

Lactation consultants are poised to care for mothers during the early weeks and months, when postpartum depression and anxiety are often diagnosed and treatment plans made. A mood disorder diagnosis often raises questions about medication and breastfeeding for mothers and nursing parents, and their care providers. This article will underscore the current recommendations for treatment and how you can work with your lactation clients experiencing mood disorders.

Lactation and mood disorders

While breastfeeding can be protective of postpartum depression (4), it is important to remember that the breastfeeding experience will impact each person differently. For some mothers, breastfeeding improves their mood and helps them feel bonded with their infant, however for others breastfeeding may not have such a positive effect (5).  

When you are working with clients who are struggling with latch issues or milk production, simplify feeding plans to reduce additional stress for these families (5). For some nursing parents, the interruption of sleep is a major contributor to their mood disturbance and it may be important to make a plan that prioritizes sleep so long-term breastfeeding goals can be achieved (5). 

There is some evidence that pain with breastfeeding may be associated with postpartum depression (6). If a client has nipple or breast pain, support them and recognize symptoms of depression. Refer the parent to their obstetrician if underlying causes of nipple or breast pain are suspected.

In addition, mothers that stop breastfeeding before they intended to are more likely to experience postpartum depression (4). As a lactation consultant, you can make a significant impact on the nursing parent’s perception of their own success. When working with people who experience an early cessation of breastfeeding, offering support, validation and empathy are particularly important. 

Mood disorders can have a lasting impact on the family unit and lactation consultants can help. The first few weeks and months after birth are a critical period of infant brain development, and PPD specifically can have a negative impact on this sensitive period (7). Untreated mood disorders can have long-term adverse health impacts for the mother, infant, and family (7). Early recognition followed by support and treatment are important to decrease the potential negative impact on the mother-infant dyad. Lactation consultants can play a critical role in supporting women who are experiencing a mood disorder and desire to breastfeed.  

Lactation consultants can screen for postpartum depression.

Routine screening for postpartum depression is a critical component for early recognition and treatment of mood disorders. The American College of Obstetricians and Gynecologists recommends screening at least once during pregnancy and at the first postpartum visit (6), and the American Academy of Pediatrics recommends screening at every well-child visit (7). 

Outpatient lactation visits offer another opportunity outside of the routine visits to ensure new parents are adequately assessed. Clients may share more with you about their feelings and emotions when they are discussing infant-feeding challenges than they do in their office visits. 

As a lactation consultant you can also screen for postpartum depression. The Edinburgh Postnatal Depression Scale (EPDS) is a free validated screener that is easy to incorporate into your clinical practice. 

Offer real help through resources and referrals.

Even though more nursing parents are being screened for depression and anxiety with their obstetrician or pediatrician, they often do not get adequate follow-up or evidence-based treatment options (7). As you provide lactation services to moms and nursing parents who may be experiencing anxiety or depression, it is important to offer support and empathy, and even more important to offer appropriate referrals and resources. 

All lactation consultants should be familiar with resources and referrals for mothers and nursing parents. This includes resources for therapists and support groups as well as psychiatric providers that are trained in perinatal mental health. If you aren’t yet familiar with resources in your area, here are a few places to start: 

  • Postpartum Support International – PSI offers support groups and local coordinators
  • Infant Risk Center – provide up-to-date knowledge on the safety of medications in breastmilk with a hotline and also apps for providers and moms
  • LactMed – a database of information about medications and breastfeeding

Postpartum medications and other treatments.

You can also support your clients by reassuring them of safe medication options for both them and their baby, and that the exposure level to an antidepressant through breast milk is far less than during pregnancy (5). Many people are given incorrect advice by healthcare professionals to quit or pause breastfeeding, even though most mental health medications are safe with breastfeeding (8).

The American Academy of Breastfeeding Medicine (ABM) recommends that if mothers are taking a selective serotonin reuptake inhibitor (Zoloft, Paxil), tricyclic antidepressant (Nortriptyline, Amitriptyline), or serotonin–norepinephrine uptake inhibitor (Cymbalta, Effexor) during pregnancy and have good results, they should continue the same medication during breastfeeding. However, many mothers are encouraged to either stop breastfeeding or stop or change their medication even when it is not an evidence-based recommendation. 

Providing your clients information about the evidence regarding other types of treatment for depression or anxiety is helpful as well. Therapy has been well studied as an effective part of a treatment plan for PPD and PPA: 

  • Cognitive Behavioral Therapy (CBT) works by helping a client recognize negative thoughts and behaviors. CBT has been well-studied and shown to be effective in treating depression (9). 
  • Support groups or peer support are also particularly helpful for some people and may work just as well as individual therapy (9).

Collaboration with other professionals for postpartum mood disorders 

As a lactation consultant you will be working within your scope to screen and refer for postpartum mood disorder. You can leverage your specific expertise to collaborate with obstetricians, pediatricians, and mental health providers. Don’t be afraid to talk to someone’s obstetrician or pediatrician about concerns or advocate for your patient’s if they haven’t gotten advice consistent with the latest evidence. 

You can also utilize or recommend the free Perinatal Psychiatric Consult Line from Postpartum Support International which connects providers to reproductive psychiatrists that can answer questions about medication management. To better support your clients, you may also consider taking training or continuing education on perinatal mood disorders. Postpartum Support International offers training, as well as a Perinatal Mental Health Certification for professionals. 

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References: 

  1. Gjerdingen DK, Yawn BP. Postpartum depression screening: Importance, methods, barriers, and recommendations for practice. J Am Board Fam Med2007;20:280–288.
  2. Dennis CL, Falah-Hassani K, Shiri R. Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. The British Journal of Psychiatry. 2017 May;210(5):315-23.
  3. Wenzel A, Haugen EN, Jackson LC, Brendle JR. Anxiety symptoms and disorders at eight weeks postpartum. Journal of Anxiety Disorders. 2005 Jan;19(3):295–311. 
  4. Dias CC, Figueiredo B. Breastfeeding and depression: a systematic review of the literature. Journal of affective disorders. 2015 Jan 15;171:142-54.
  5. Sriraman NK, Melvin K, Meltzer-Brody S, Academy of Breastfeeding Medicine. ABM clinical protocol# 18: use of antidepressants in breastfeeding mothers. Breastfeeding Medicine. 2015 Jul 1;10(6):290-9. Available from: https://www.liebertpub.com/doi/full/10.1089/bfm.2015.29002
  6. ACOG.  Breastfeeding Challenges. Committee Opinion No. 820. Available from: https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2021/02/breastfeeding-challenges
  7. Earls MF, Committee on Psychosocial Aspects of Child and Family Health. Incorporating recognition and management of perinatal and postpartum depression into pediatric practice. Pediatrics. 2010 Nov 1;126(5):1032-9.
  8. ACOG. Screening for Perinatal Depression. Committee Option No. 757. Available https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2018/11/screening-for-perinatal-depression
  9. Fitelson E, Kim S, Baker AS, Leight K. Treatment of postpartum depression: clinical, psychological and pharmacological options. International journal of women’s health. 2011;3:1.