Q: Breastfeeding and Postpartum Depression
I am bipolar and 7 months pregnant. Up to this point, I have
agreed with my doctor and have planned not to breastfeed and start on my
medications right after birth. I am now having second thoughts and am
thinking I might want to breastfeed. I do not, however, want to get
postpartum depression. Iam planning on having a baby nurse for a week who
will feed my baby expressed milk during the night so that I may get my rest.
Is this just a stupid thing to do? I have been feeling great during
my pregnancy and am feeling like I never want to take another pill or feel badly
again. I had heard that nursing can sometimes keep postpartum at bay.
What is your advice?
Dear Ms. R'
This is one of the trickiest areas in the treatment of bipolar disorder.
You must work very closely with your doctor here. To my knowledge, nursing
has not been shown to "keep postpartum at bay". I just searched Pub
Med for "bipolar postpartum breastfeeding". I saw nothing
there to suggest that people are thinking nursing will protect you, although
there could be some smart folks who've figured this out who don't publish in the
medical literature -- or I could easily have missed something!
I just attended a conference yesterday in which Dr.
Hendrick from UCLA spoke on this topic (she does research in this area).
You might want to try to get an opinion from such an expert. It does seem
clear that postpartum depression is a high risk (in another context, I've heard
50% of women with bipolar disorder will get a postpartum
depression). Your idea of having a baby nurse for a time seems like
a great idea, as the sleep deprivation associated with nighttime baby care is
definitely a concern. That's probably a good idea no matter what you
decide about breastfeeding.
As you'll see if you do that same search (the link
above will show you how if that's not familiar for you), lithium is believed not
to be a good idea for breastfeeding moms. The American Academy of
Pediatrics has ok'd Depakote, but several folks have written that this
"ok" was based on too little data. Since then several studies
have measured Depakote levels in the baby when mom is taking it. Kids seem
to get between 1-6% of mom's blood level, from the abstracts you can read on
that search. As far as I know, no one knows if that low blood level in
baby is of any concern. There is a single case report of a blood problem
(too few platelets), that Depakote can sometimes cause, in a baby when mom was
taking Depakote (but there are more problems with other medications,
I was just thinking "now what would I want for my
kid?" but you really would want someone like Dr. Hendrick or one of the
several other well recognized experts to tell you their answer to that one, not
me. Tough call.
Published October, 2001