Perinatal Mood disorders impact  10-20% of women. As May is Mental Health Awareness month we're highlighting Academy of Breastfeeding Medicine Protocol #21 (Use of Antidepressants in Breastfeeding Mothers) & Protocol #18 (Substance use and Breastfeeding) 

How can primary care providers help? 

• Screen for postpartum mood disorder at routine postpartum visits and infant well child care visits. 
• Use a standardized tool for screening tool like the Edinburgh Postpartum Depression Screen (EPDS)- (See below for a link with information about EPDS-US) 
• Increase breastfeeding support for families with feeding difficulties, as early negative breastfeeding experiences are associated with increase postpartum depression symtpoms.
• Personalize the care and ask about breastfeeding:  "Some mothers with
  depression find that breastfeeding enhances bonding and improves their mood, whereas others find breastfeeding to be difficult."
• Support families in choosing antidepressant medications when needed.  See the protocol for more detailed discussion on meds, and for up to date information on medications and lactation see LactMed and  e-lactancia 

Substance use and breastfeeding support highlights:

• Recognize the frequency of non-prescribed substance use and be prepared to counsel with regards to breastfeeding.  The protocol notes that "the United States (US) 2021 National Survey on Drug Use and Health (NSDUH) data found that 7.7%, 10.8%,and 9.8% of pregnant women reported past-month nonprescribed substance use, tobacco product use, and alcohol use, respectively."
• "Breastfeeding initiation timing: Individuals who discontinue  nonprescribed substance use by the delivery hospitalization can be supported in breastfeeding initiation."
• "Mothers motivated to breastfeed who report recent nonprescribed
  substance use and/or have positive toxicology testing at delivery should be supported in expressing milk to establish milk production."
• "Perinatal breastfeeding support: Targeted perinatal  breastfeeding care such as prenatal education, inpatient and postpartum lactation support, and ongoing multidisciplinary" substance use disorder(SUD) support
• See the protocol for specific recommendations on opiods,sedative hypnotics, stimulants, alcohol, cannabis, nicotine use and breastfeeding
• See the protocol for detailed discussion of compatible SUD treatments while breastfeeding (i.e.) methadone, buprenorphine, and naltrexone and noncompatbile treatments (i.e. disulfiram).

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Research Updates

Impact of Breastfeeding Difficulties on Maternal Mental Health

• Survey asking how breastfeeding difficulties impacted mental health
• Study results supported the importance of increased support.   More specifically:  "(1) education around the realities of what to expect when breastfeeding, (2) support for technical challenges and pain management, and (3) education for healthcare professionals, families and wider society on the importance of supporting breastfeeding mothers who are experiencing breastfeeding difficulties."
• from Scientific Reports, 2025

Negative Emotional Experiences of Breastfeeding and the Milk Ejection Reflex

• Breastfeeding aversion response (BAR) and dysphoric milk ejection reflex (D-MER) are phenomena that contribute to unpleasant feelings and sensations during breastfeeding.
• from International Breastfeeding Journal, 2025

Breastfeeding after Traumatic Childbirth

• In this study following a traumatic birth experience,  breastfeeding women at 2 weeks postpartum reported fewer symptoms of mother‒infant bonding difficulties, compared with non-breastfeeding women, p = 0.004. 
• The study followed participants through 9 weeks and found in a descriptive analysis that non-breastfeeding families had more PTSD and depression symptoms.
• The study authors underscore "the need for targeted interventions to support breastfeeding and bonding in this population."
• from Journal of Psychosomatic Obstetrics & Gynecology, 2025

Helpful Resources

• Breastfeeding & Substance Use, handout for parents from Academy of Breastfeeding Medicine
• D-MER.org, web platform dedicated to education & awareness about Dysphoric Milk Ejection Reflex
• EPDS-US, The Edinburgh Postnatal Depression Screen (EPDS) adapted for use in the United States