There are many things to take into account when you decide
whether you want to breastfeed and take medication for ADHD. Because breastfeeding has its own effect on
how the mind works, some women may not need medication while they are
breastfeeding. You must also take into
account whether the medication you take may transfer to your infant through
breast milk and whether the medication may affect your milk supply. This article discusses these issues and
alternative routes you can take in making the decision of how you will feed
your baby and whether taking medication while breastfeeding is for you.
Transfer of
medications in the breastmilk
Methylphenidate and
amphetamines. Case reports suggest
that the amount of methylphenidate and amphetamines ((including Ritalin,
Adderall, and Dexedrine) transferred
from mother to infant is very small, and that infants do not seem to be
affected by the tiny amount of medication.
Atomoxetine. There are no published reports of breastfeeding
while on atomoxetine. Reports from the manufacturer found no serious adverse effects in 2 infants.
Guanfacine. There are no published reports of
breastfeeding while on guanfacine.
Clonidine. The medication can pass from mother to infant
in breast milk, producing an average of 66% of the average serum level found in
the mother in one study of 9 infants, although the infants in the same study
showed no side effects.
Bupropion. There is a single case report of a
breastfeeding infant who had a seizure after its mother started bupropion. No bupropion levels were measured in the infant
so it is not clear whether the seizure was due to bupropion, especially since
such levels have been reported to be very low or undetectable in other infants.
Strategies for
minimizing exposure. There is a not
a lot of information out there about how soon after dosing medications reach
their peak concentrations in breast milk, so pumping and dumping is not a
guarantee of drug free breast milk. You
may be able to minimize the amount of medication that reaches the breast milk
by only taking your medication on days when you need it. This strategy will only work for stimulants,
however, since nonstimulants need to be taken for a certain time period (weeks)
before they are effective.
Effect of medications
on supply
Methylphenidate and
amphetamines. These medications
lower the amount of prolactin in the blood, however no studies have been done
to show whether mothers who take these medications actually make less
milk. Mothers who have an established
milk supply may not require as high levels of prolactin to make milk.
Guanfacine. Guanfacine decreases prolactin in men and
women who are not breastfeeding, but there are no reports of what it does
during breastfeeding.
Clonidine. Clonidine has complex effects on oxytocin and
prolactin levels and may either increase or decrease milk secretion.
Bupropion. One case report suggested that bupropion may
have caused high levels of prolactin in a patient who was not breastfeeding,
otherwise there is no good information on what bupropion does to supply in breastfeeding
patients.
Strategies for
optimizing supply. Milk supply is
established over the course of the first 6 weeks, more or less, so waiting for
this long before taking a stimulant may help protect your supply of milk. Taking a break from medication (on days when
you are off work, for example) may also help.
Appetite Issues
A side effect of many ADHD medications, especially the
stimulants and atomoxetine, is a decrease in appetite. This may not be helpful for milk supply. To keep an adequate supply, you should count
on eating 300-500
extra calories per day, above what you needed to keep your weight stable
before you were pregnant. The amount
will vary depending on how much milk you need.
Some strategies
you can try to increase your intake are relatively easy to put into action
if your appetite is suppressed.
Alternatives to Taking
Medication While Breastfeeding
Staying off
Medication. Breastfeeding is time
limited, typically a year or two at the most.
You can choose to stay off medication so long as your mental functioning
is adequate--that is, that you are not depressed or unable to take care of you
and your infant's basic needs.
Omega 3 fatty acids. DHA supplements for pregnant and lactating
women abound due to the possibility that omega 3 fatty acid supplementation may
encourage healthy development of the eyes and brain. The effect of omega 3s on ADHD symptoms is
debatable, but a supplement may allow you to lower your dose of medication and
the supplement may also benefit your baby.
Diet. Dietary changes are controversial when it
comes to controlling ADHD symptoms.
Lactation is not a good time to start an elimination diet, though it is
always a good time to cut out junk food and artificial colors.
Coaching. While coaching may not affect lactation, it
may be difficult to attend coaching appointments while tending to an infant,
especially at first. Be sure that your
coach will allow you to feed and that you will feel comfortable feeding, during
coaching if necessary.
Formula Feeding. If you decide not to breastfeed after
all, you are not a bad mother. Breast milk
is better than formula if everything is the same, but medicated breast milk is
not the same as unmedicated breast milk. Many moms
choose formula for much lesser reasons than having to take medication. The thing your infant needs most is not
breast milk, but a mother who is able to function mentally and feel comfortable
about her feeding choices.
References:
US National
Library of Medicine. "LactMed Search." LactMed Search. US National
Library of Medicine, n.d. Web. 7 Sept. 2015.
<http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT>.
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