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. Then there are medication considerations: does yours pass into the breast milk, or could it affect supply?
Transfer of medications in the breast milk
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.
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 breastmilk 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 depend on 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 a day when you are off work, for example) may also help.
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 300-400 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 this becomes a problem for you.
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 may or may not be better than formula. 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.
Bonyata, Kelly. “Do Breastfeeding Mothers Need Extra Calories or Fluids?” KellyMom RSS . KellyMom.com, 2 Aug. 2011. Web. 04 Feb. 2014.
US National Library of Medicine. “LactMed Search.” LactMed Search. US National Library of Medicine, n.d. Web. 27 Jan. 2014. .