Do you have any information on ADD meds and compatibility with breastfeeding? I need to continue breastfeeding my daughter (5mo) due to food allergy issues, but I also need to function in my job, which, due to a recent increase in job demands, is getting very difficult. I can only pass my inattention off as sleep deprivation for so long and my non-med coping strategies aren’t cutting it. I don’t want to have to tell my employer that I have trouble with ADD because it, well, sounds so needy to me.

I finally landed a wonderful job with great insurance and found a fabulous family practitioner who feels comfortable prescribing stimulant medication, but now I am faced with a dilemma about risk/benefits of ADD meds and breastfeeding. Is there any information out there that may shed some light?
VR

Dear VR:
Breastfeeding is critically important to the bonding experience of mother and infant and there has been a growing trend to promote breastfeeding. Therefore, decisions to breastfeed ought to be made with the most up-to-date information when considering psychiatric medications.

Current information indicates that the amphetamines are concentrated in breast milk and may cause symptoms of withdrawal in the infant. At this time, the recommended is that these drugs not be used while nursing. It is not known whether methylphenidate is excreted into breast milk.

Alternatives to stimulants in treating ADHD – Wellbutrin and clinidine (Catapres), are both excreted in human milk and should NOT be taken by nursing mothers.

Tricyclic antidepressants have been shown to be effective in treating the primary symptoms of ADHD and might be considered for use when a woman is breastfeeding. However, selective serotonin reuptake inhibitors (SSRIs) are not indicated for the treatment of ADHD symptoms.

I suggest that you discuss this information with your physician and then make an informed decision regarding taking medication while you are breastfeeding.

In the meantime, you need to do all that you can to take care of yourself and minimize the impact of your ADHD symptoms. This includes getting help at home with the housework and daily chores. You should also try to get as much sleep as possible and try stress reduction techniques such as relaxation and yoga.

Meet with a coworker or coach to develop strategies to help deal with the workload in the office. Break projects down into manageable goals and work on each separately. Ask for a written job description with expectations clearly defined. Get all deadlines and an outline of projects with definable goals in writing. Look for areas to work that provide a minimum of distraction and set up breaks for yourself throughout the day.

Your child will soon be weaned and it is important to make a decision that you can live with now and into the future. In the meantime, you will also be developing habits and strategies that allow you to function at your best on the job, with or without medication.