I am bipolar and 7 months pregnant.  Up to this point, I have agreed with my doctor and have planned not to breastfeed and start on my medications right after birth.  I am now having second thoughts and am thinking I might want to breastfeed.  I do not, however, want to get postpartum depression.  Iam planning on having a baby nurse for a week who will feed my baby expressed milk during the night so that I may get my rest.  Is this just a stupid thing to do?  I have been feeling great during my pregnancy and am feeling like I never want to take another pill or feel badly again.  I had heard that nursing can sometimes keep postpartum at bay.  What is your advice?

Dear Ms. R'
This is one of the trickiest areas in the treatment of bipolar disorder.  You must work very closely with your doctor here.  To my knowledge, nursing has not been shown to "keep postpartum at bay".  I just searched Pub Med for "bipolar postpartum breastfeeding".  I saw nothing there to suggest that people are thinking nursing will protect you, although there could be some smart folks who've figured this out who don't publish in the medical literature -- or I could easily have missed something!  

I just attended a conference yesterday in which Dr. Hendrick from UCLA spoke on this topic (she does research in this area).  You might want to try to get an opinion from such an expert.  It does seem clear that postpartum depression is a high risk (in another context, I've heard 50% of women with bipolar disorder will get a postpartum depression).   Your idea of having a baby nurse for a time seems like a great idea, as the sleep deprivation associated with nighttime baby care is definitely a concern.  That's probably a good idea no matter what you decide about breastfeeding.  

As you'll see if you do that same search (the link above will show you how if that's not familiar for you), lithium is believed not to be a good idea for breastfeeding moms.  The American Academy of Pediatrics has ok'd Depakote, but several folks have written that this "ok" was based on too little data.  Since then several studies have measured Depakote levels in the baby when mom is taking it.  Kids seem to get between 1-6% of mom's blood level, from the abstracts you can read on that search.  As far as I know, no one knows if that low blood level in baby is of any concern.  There is a single case report of a blood problem (too few platelets), that Depakote can sometimes cause, in a baby when mom was taking Depakote (but there are more problems with other medications, particularly lithium).  

I was just thinking "now what would I want for my kid?" but you really would want someone like Dr. Hendrick or one of the several other well recognized experts to tell you their answer to that one, not me.  Tough call. 

Dr. Phelps  

Published October, 2001