Need advice regarding a mother with probable attention deficit disorder.
Most of what I find in the archives seems to pertain to children rather than
mothers.  Brief history as follows:

35 yo mother nursing her fourth child has been pregnant and/or nursing
continually for the past eight years.  Has had some difficulties with
postpartum depression which are successfully treated with citalopram, but
has complained of ever-worsening difficulties with attention, concentration
and memory which have not improved with treatment.  In fact, the patient
believes they have gotten worse with each pregnancy and throughout the
course of breastfeeding.  Her current nursling is 9 months old, but nurses
quite frequently and does not consume much solid food yet.

There is a very strong history of attention deficit (and hyperactivity)
disorder in the family, including siblings who are successfully treated w/
methylphenidate as adults and even the patient's father (other family
members have undergone neuropsychiatric testing to confirm the diagnosis).
Though successful throughout her schooling and career, the patient has
always had trouble with restlessness, distractibility, attention, task
completion, etc.  Her psychiatrist (who treats this patient's other family
members who have ADD/ADHD) believes that this patient also has ADD and
recommended a trial of methylphenidate.

Unfortunately, it looks like methylphenidate (and other ADD treatments)
would not be very compatible w/ breastfeeding.  She has already tried and
failed bupropion due to severe insomnia so that is not an option.  The
patient has breastfed all of her children to preschool age and will not wean
this child early, but is desperate to receive some help.  She has reached
the point where she feels it's impairing her functioning at her job.  She
works part-time and does pump milk during absences.  She would consider
'alternative' therapies as well as standard medical treatments.

I would appreciate opinions on this case and any suggestions for treating
this woman.  Have any of you worked with breastfeeding mothers with
ADD/ADHD?  What has your experience been?  Is it possible that the extended
length of time being pregnant and/or breastfeeding could worsen the ADD
symptoms?  I'd hate to see breastfeeding made the scapegoat of yet another
condition, but, considering how many women complain of memory problems
relating to pregnancy and nursing, this seems possible.  Are there any
therapies you've seen used with success?  Could methylphenidate be tried in
some fashion?  Perhaps in low dose or only on days when the mother is away
at work?  Milk from those days could be discarded if necessary.  This mother
will not wean because of this, but could use some help.

Any thoughts, insights, experiences, and/or suggestions would be
appreciated.

Catharine C. Decker, MD
Family Medicine/Urgent Care
Luther-Midelfort Clinic
Mayo Health System


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