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Sunday, March 9, 2008

Bipolar, Breastfeeding, and Board Exam

Continuing from the previous post. There is always a few questions on the Family Practice Board Exam about Bipolar, Lithium and Breastfeeding. The "correct" answer would be the choice making the association that breastfeeding and Lithium are incompatible. It's a no wonder than that physicians tell their bipolar clients that they can't breastfeed; its what they've learned.

Now do you think, I tell Bipolar clients they can't breastfeed? First of all, an individual assessment is important. "Bipolar" is used loosely and people use the term meaning a whole range of different scenarios. When I first learned of bipolar it meant Manic/Depressive--going from psychotic highs (mania) to psychotic lows (severe depression). I hear it being used more casually to mean anyone who has ups and downs. So the first thing I would do is determine if its really Bipolar and consider what medications are used for treatment.

For "real" bipolar then I would consider the possible use of the safest medications and make recommendations to the treating psychiatrist. If not possible to change medications or minimize dosage and the mother will truly be on Lithium and antipsychotics, I can monitor the mother and baby closely by physical exam, by blood test, by breastmilk drug levels. I did something like that for Sarah when she needed Iodine for her thyroid. Why put a baby on formula automatically when we know formula has definite risks vs. a ttheoretical risk from a low exposure of medication. Breast is always best.

If the mother is psychotic she would be a risk to her baby and that would be a contraindication to breastfeeding.

As far as the casual uses of calling someone bipolar, there is so many scenarios. In the worst case I would do the same monitoring as above. In cases not so extreme, I can probably work out breastfeeding.

It is important for a woman with bipolar to find someone specializing or interested in breastfeeding medicine. Getting a referral through the Academy of Breastfeeding Medicine or La Leche League Medical Associates is a start. I know that some members will provide highly individual care, but there are also associates who are very conservative or may be associates new to all this.

I would also include a vitamin and nutritional assessment to determine if there is a treatable underlying cause for the psychiatric symptoms. Depression has been proven to be associated with B vitamins and folate deficiencies.

4 comments:

Natalie said...

Thank you. :)

Natacha said...

I love your perspective and I totally agree with your position on this issue (good advice) :)

Permission to Mother said...

Now, that I've completed testing, I noticed there was no questions on Bipolar and breastfeeding... there was not many breastfeeding questions, but they were cut n dry and not so vague. :)

Monica said...

i have "bipolar 2", and even though its not "real" bipolar it is still a severe mood disorder that does impact my life in a very real way. Mania psychosis is not something i have dealt with, thank goodness. However, the depression can be crippling. I have found benefits with vitamins (namely, EMPowerPlus by a company called TrueHope). The problem is the supplement irritates my 8 month olds stomach. I tried Prozac for a couple months, but it started to make me rapid cycle, things just got worse and worse. And when i tried Welbutrin for a time it began to dry up my milk supply. in fact, my supply has suffered ever since, so i took fenugreek to increase supply - and that made the baby scream. This is my third child and i breast fed my 2nd child for 17 months... but this time the depression is worse. I can't deal with this painful fog. I can't function. I am interested in starting welbutrin again and taking it with EMPowerPlus, but i know the welbutrin will dry up my milk. I am torn. I guess i will just suffer through another 4 months of nursing before i start the welbutrin. some days i don't think i'm going to make it till her 1st birthday. I think Lamictal also looks like it could be beneficial to me, but it isn't ok to take while nursing either. This is torturous. I believe in breast feeding, and a part of me loves it dearly... but my mental health is more beneficial than my milk. with all of the "known risks" of formula - children do still not only survive, but thrive on it. i know it shadows in comparison to breast milk - but it has a place, and i'm thankful it exists. I'm not going to stop nursing... but this is a huge battle i feel i wake up every day to fight.

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