Managing attention-deficit/hyperactivity disorder in a breastfeeding mother: A case report

Attention-deficit/Hyperactivity Disorder (ADHD) is increasingly recognized in adult women. However, clinical guidance on prescribing ADHD medications during breastfeeding remains limited. Despite the effectiveness of ADHD medications, concerns about drug transfer into breastmilk often lead to conservative prescribing or discontinuation of therapy during the perinatal period, compromising maternal well-being.

In this report, we present a case of a 25-year-old woman at 3 weeks postpartum and exclusively breastfeeding, who presented with ADHD combined type, with inadequate symptom control on extended-release bupropion 300 mg daily. Given poor tolerance at higher doses of bupropion, she was initiated on immediate-release methylphenidate and switched later to the extended-release formulation to minimize the risk of activation previously experienced with antidepressant use.

Both mother and infant were monitored for 6 months after medication initiation, during which the mother reported improvements in hyperactive and impulsive symptoms as reflected by scoring of the Adult ADHD Self-Report Scale. She also reported improvements in concentration, mood, and functioning. There were no adverse effects on milk supply, and the infant demonstrated normal growth and development.

This case underscores the feasibility of cautiously escalating stimulant therapy in a breastfeeding mother with ADHD, showing improved functioning in the mother without immediate effects on development in the infant. Significant gaps persist in guidance for postpartum ADHD care, underscoring the need for more research to inform safe and effective treatment.