Connie:
A great deal more information about this woman, her situation, her
diagnosis, and her physician is needed for me to responsibly offer any kind
of clinical opinion about this particular case. Nonetheless, I have not
come across anything in the breastfeeding literature that supports the
contraindication of breastfeeding based solely on a diagnosis of
depression. My questions include:
1. What are the qualifications (training, experience,
licensure/certification) of this physician in both the fields of mental
health and breastfeeding? Is this an ob-gyn or family doctor, a
psychiatrist, ...?
2. Is the doctor's concern based on the emotional aspects of depression
(which vary between and within unipolar and bipolar depression) or based on
the medications being used?
3. Is the concern only about a "past history" of depression or about an
on-going depression that is currently being treated?
4. Is the doctor aware of treatment alternatives (e.g., different
medications, different psychological treatments, combining biological and
psychological treatments)?
5. Is this doctor aware of resources (e.g., AAP's list, Hale's book) that
provide information on medications in mother's milk and their impact on
breastfeeding and the nursling?
6. Are common social risk factors (e.g., isolation, loneliness,
relationship issues, experiences in which a woman has no control [typical
birth experiences in the US, for example, ...]) for depression--be it
postpartum or not--being addressed (e.g., what is this woman's life like,
what could be changed that might eliminate or ameliorate the depression)?
Take a look at Sheila Kitzinger's "The Crying Baby" for a detailed
discussion of the concrete impact of such social factors on women's
well-being and their experience of mothering.
7. Is this doctor aware that lactation is the NORMAL (healthy) postpartum
hormonal state? Or does he/she think that by not breastfeeding, postpartum
depression will somehow be hormonally avoided?
People run real risks for depression when they are unable to engage in
activities and aspects of themselves that are of great meaning to them.
Depression is not uncommon among women who have been unable to (or
prevented from) breastfeeding when breastfeeding is something that they
deeply wanted to experience for themselves and for their babies. The loss
of breastfeeding is worthy of grief--and depression is a common part of
grief. In my opinion, being coerced into not breastfeeding due solely to a
"past history of depression" may result in greater risk of postpartum
depression.
In the context of the use of lithium (used to treat bipolar depression) and
breastfeeding, Schou (1990) states: "Accumulating evidence points to the
beneficial effects of breastfeeding for both child and mother, mentally and
physically, and it is an open question whether the gain outweighs the
losses when breastfeeding is avoided. Supported by husband and physician,
the mother must make her own choice."
Schou, M. Lithium treatment during pregnancy, delivery, and lactation: an
update. J. Clin. Psychiatry 51(10):410-3, 1990.
I hope that this woman will have the opportunity to come to a truly
informed decision about breastfeeding or not in the context of
relationships with health care providers that are knowledgeable about
breastfeeding as well as about treatment alternatives for depression. From
the mother's report, this woman does not appear to have come to a decision
with which she is comfortable. A second (or third) opinion is appropriate.
LLL Leaders and LCs can play critical roles in helping women sort through
such questions and options in an empathetic and respectful manner. One may
need to take a bit more initiative than normally taken when working with
depressed women. Calling again, sending a note, something just a bit
"extra," to clearly convey continued availability to discuss concerns and
options may be very appropriate.
Breastfeeding is empowering for many women. Empowerment is a very good
thing for all aspects of women's well-being: including their mental health.
Apologizing for length,
Cynthia Good Mojab, MS Clinical Psychology
(Breastfeeding mother, advocate, independent researcher and author; LLL
Leader and researcher in the LLLI Publications Department; and former
psychotherapist currently busy nurturing her own little one.)
Ammawell
Email: [log in to unmask]
Web site: http://ammawell.homepage.com
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