Breastfeeding and Maternal Mental Health: Understanding the Benefits, Risks, and Medication Considerations

Breastfeeding is one of the most profound and intimate forms of bonding between a mother and her child. It is a practice that varies between cultures globally, but is widely recognized by the scientific community for its nutritional and developmental benefits for infants [1]. However, breastfeeding also plays a significant role in the mental health of mothers, particularly those who may be navigating the complexities of postpartum mental health disorders. In light of the increasing relevance of perinatal mental health as a prevalent driver of post-pregnancy complications and maternal mortality, breastfeeding has become increasingly researched within health psychology [2]. In this article, we explore the multifaceted relationship between breastfeeding and maternal mental health, examining the benefits, risks, and considerations surrounding psychotropic medication use during breastfeeding.

 

The Intersection of Breastfeeding and Maternal Mental Health

Maternal mental health is a broad term that encompasses a range of emotional and psychological states that mothers experience before, during, and after pregnancy. Postpartum depression (PPD), anxiety, and other mood disorders affect a substantial portion of mothers, with some estimates suggesting that up to 1 in 7 women experience PPD [3]. These disorders can severely impact a mother’s well-being, her ability to bond with her infant, and her overall quality of life. The postpartum period can be a time of profound vulnerability, but it is also a time when proper social support, counseling, and medical care, both psychiatric and reproductive, can promote recovery.

Breastfeeding, as part of the postpartum experience, can have both positive and negative impacts on a mother’s mental health, depending on individual and sociocultural circumstances. Some mothers find that breastfeeding helps them feel closer to their baby, fosters a sense of accomplishment, and provides relief from emotional stress. However, others may find the act of breastfeeding emotionally and physically draining, especially if breastfeeding challenges arise, infant health complications take place, or if the mother is already struggling with mental health issues.

 

The Psychological Benefits of Breastfeeding

Hormonal Impacts

Breastfeeding triggers the release of several hormones, including oxytocin, often known colloquially the “love hormone.” The role of oxytocin during delivery helps to accelerate contractions and to trigger the “let down” of milk during breastfeeding, but oxytocin also plays a crucial role in promoting maternal bonding, reducing stress, and enhancing feelings of calm and relaxation [4]. These hormonal effects are not only beneficial for the infant but can also have a profound impact on the mother’s emotional state. This maternal-infant bonding can enhance maternal confidence and reduce feelings of isolation or emotional disconnection, which are common risk factors for conditions like postpartum depression. Another hormone, prolactin, released during breastfeeding helps in milk production but also has a calming effect on mothers, which can contribute to improved mood and a sense of well-being. Mothers with elevated levels of prolactin also report higher levels of attentiveness and responsivity to infant cues, so the hormonal impacts of breastfeeding have benefits across both maternal and child health [5].

Mood Regulation

Breastfeeding is associated with a decrease in the stress hormone cortisol and reduces a mothers’ HPA-axis reactivity [6]. Elevated cortisol levels are linked to increased anxiety and depression. Therefore, breastfeeding may help regulate a mother’s mood and reduce the likelihood of stress-related mental health issues. Many women even report a sense of emotional uplift, joy, or relaxation following breastfeeding sessions, though this is not universal.

Breastfeeding can foster feelings of accomplishment and satisfaction. The act of nourishing one’s baby may provide mothers with a sense of purpose and emotional fulfillment. This can be particularly important in preventing or alleviating depressive symptoms, as it can bolster self-esteem and a sense of control in the face of postpartum challenges.

Social Support

Mothers who breastfeed often find themselves joining social networks and support groups, both online and in-person, that can provide emotional support and connection [7]. These communities can play a crucial role in helping mothers navigate the challenges of both breastfeeding and mental health. Creating safe spaces for lactation can reduce much of the shame or stigma around public breast feeding, which may be another benefit of these peer groups. Positive social interactions can also serve as a buffer against the onset of depression and anxiety [2].

 

Psychological Considerations with Breastfeeding

Breastfeeding Challenges and Emotional Strain

While breastfeeding offers numerous benefits, it is obviously not without its challenges, and it may be a different experience for every mother. Difficulty latching, painful nipples, low milk supply, and concerns about infant nutrition can lead to frustration and emotional distress [8]. For some mothers, the pressure to breastfeed “perfectly” can exacerbate feelings of guilt, inadequacy, and anxiety, particularly if things are not going as planned. In an especially challenging feedback loop, experiencing stress, anxiety, or shame around breastfeeding can make the process of lactation physiologically harder to achieve. Anxiety about whether the baby is feeding enough or whether the mother is producing sufficient milk can be a significant source of stress [9]. This is particularly true for mothers who may already have a history of anxiety disorders. Constantly monitoring the baby’s feeding patterns can lead to obsessive thoughts, health anxiety, and heighten feelings of helplessness for some, but may also be empowering and insightful for others. The exhaustion, emotional vulnerability, and physical demands of breastfeeding can worsen symptoms of depression. In some cases, the added pressure to exclusively breastfeed can contribute to feelings of failure or distress. Ultimately, the ideal breastfeeding plan is one that takes into account both maternal and infant needs, mentally and physically. Further, the physical demands of breastfeeding on the body, especially during the early months when feeds are frequent, can lead to physical and emotional fatigue [10]. Exhaustion can exacerbate depressive symptoms and make it more difficult for mothers to care for themselves or their babies.

Psychotropic Medications and Breastfeeding

One of the most critical concerns for mothers with postpartum mental health issues is the question of medication safety during breastfeeding. Many mothers with conditions such as postpartum depression, anxiety, or bipolar disorder may need to continue or begin psychiatric treatment during the postpartum period [11]. The decision to use psychotropic medications while breastfeeding must take into account both the safety of the infant and the mental health of the mother, as well as the stigma around help-seeking that new moms may face.

Selective Serotonin Reuptake Inhibitors (SSRIs)

SSRIs, which are commonly prescribed for depression and anxiety, are generally considered safe for breastfeeding mothers [12]. Medications such as sertraline (Zoloft) have been studied extensively, and the consensus is that they have low levels of transfer into breast milk. The amount of medication passed through breast milk is typically very small and not thought to pose significant risk to the infant. However, some side effects, such as drowsiness or gastrointestinal upset, may occur in a small number of infants. In fact, SSRIs are often the first-line treatment for postpartum depression and anxiety in breastfeeding mothers because they are effective, relatively safe, and well-tolerated by most women.

Tricyclic Antidepressants (TCAs)

Older antidepressants like amitriptyline and nortriptyline are also considered safe for breastfeeding, though they are less commonly used today due to their side effects. These medications are known to pass into breast milk, but the concentrations are typically low and unlikely to cause harm to the baby, especially if the infant is older than 2 months [13].

Benzodiazepines

Benzodiazepines (e.g., diazepam, lorazepam) are sometimes prescribed for anxiety or insomnia. However, these medications are generally not recommended for breastfeeding mothers, as they can pass into breast milk in significant amounts and may cause sedation or respiratory depression in the infant [14]. Depending on the drug dosing, infants who are exposed to benzodiazepines through breast milk may experience side effects such as lethargy, poor feeding, and respiratory issues. For mothers needing treatment for anxiety or insomnia, non-benzodiazepine options are usually preferred.

Antipsychotics

Antipsychotic medications like quetiapine (Seroquel) and aripiprazole (Abilify) are sometimes used for more severe psychiatric conditions, including postpartum psychosis or bipolar disorder. Some antipsychotics are considered relatively safe during breastfeeding, but mothers must work closely with their healthcare provider to monitor the effects on both themselves and their infants.

One review reported that olanzapine and quetiapine were considered the two most acceptable antipsychotics for use during breastfeeding [15]. While many modern antipsychotics have low transfer rates to breast milk, there is still limited data regarding their safety. Newborns and infants are particularly vulnerable to side effects, and mothers may be advised to wait until the infant is older before resuming these medications.

Mood Stabilizers

Mood stabilizers such as lithium are sometimes used for bipolar disorder, but they require careful consideration when prescribed to breastfeeding mothers. Lithium can pass into breast milk, and high levels in the infant can lead to toxicity. Due to the risks of lithium toxicity, it is generally recommended that mothers either avoid breastfeeding or use alternative medications while taking lithium [16]. Changing any psychiatric medications, especially within the vulnerable postpartum period or while breastfeeding, is a process that should follow close collaboration with a medical professional. Information in this article should not be taken as direct medical advice, rather a starting point to ask further questions of your providers and broadly understand the relationship between maternal psychological wellbeing and breastfeeding.

 

 A Balanced Approach to Breastfeeding and Mental Health

Breastfeeding offers numerous benefits for both mother and child, but it can also present unique challenges for mothers struggling with mental health conditions. Postpartum mental health is a complex and multifaceted issue, and there is no one-size-fits-all approach to treatment. For mothers who are dealing with postpartum depression, anxiety, or other mood disorders, it is crucial to strike a balance between providing for the child’s nutritional needs and caring for the mother’s mental health.

The decision to breastfeed while managing mental health conditions should be made with the advice of healthcare providers, considering factors such as the severity of the mental health disorder, the medications being used, and the mother’s holistic well-being. For most women, SSRIs and other medications with low milk transfer rates can help manage psychiatric conditions without significantly impacting the infant’s health. However, careful monitoring and individualized treatment plans are essential to ensure both maternal and infant health.

Mothers should be encouraged to seek support—whether from healthcare professionals, doulas, midwives, lactation consultants, or support groups—to navigate the challenges of both breastfeeding and mental health care. The goal should always be to ensure that both mother and baby are supported, healthy, and thriving, psychologically, physically, and socially, during the postpartum period.