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Making the Decision to Breastfeed or Medicate for My Mental Health

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I want to begin by expressing my gratitude for what I have in my life and acknowledge I am writing from a place of privilege. While my following story deals with a personally difficult decision, I am thankful I have the opportunity to make a decision in a circumstance where there is not a single best answer. There are many others in the world, facing much more dire situations where they have far less control. I write this piece because it happens to be the next step on my personal journey to learn more about my health and happiness.

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What is ADHD?

When my oldest son was born, I set a goal to breastfeed him for a full 12 months, assuming that plan was best for us. Like many breastfeeding stories, mine was turbulent, but the perfectionist in me was stuck on the arbitrary goal of reaching the 12 month mark. There was pain, sleeplessness, back aches, concern over short feedings and small supply, unrecognized postpartum depression (PPD), and so much pumping, but I felt we were going to nurse for 12 months despite all these hurdles. Then to my surprise, my sweet son decided he was “all done” at age 10.5 months.

I spent over a week troubleshooting, calling lactation consultants and other providers. But that stage of our relationship had officially come to an end, and there wasn’t anything I could do about it. After being caught off-guard by the sudden change in routine, I experienced profound depression and hopelessness. Crying for the better part of two weeks, I scoured the mommy blogs for similar experiences, desperate to make a connection with someone who understood my same devastation. I don’t remember finding anything supportive. Among my very few friends and family I tried consulting, it was always the mother who decided  when to wean, whether at birth or many months later.

Of course, time went by and I ultimately adjusted. Now, several years later, I still comfort-nurse my 2.75-year-old youngest son. When he was an infant, I was better attuned to catching and treating my PPD, which helped with my everyday anxiety as well. By reducing my anxiety and the need to do things perfectly, I prepared myself for the day when my youngest might wean himself. I had become an expert in finding alternate perspectives, so I knew there would be tradeoffs regardless of who initiated the weaning and when it would occur.

Well, one year came and went, and since I intended to wean him around 12 months (and was pleased he had stuck with it this long too), I decided to educate myself on the steps to successful weaning. In my reading, I was surprised to learn that most babies do not willingly choose to wean from breastfeeding until 18-24 months. I casually decided to let my son take the lead and agreed to tentatively continue breastfeeding until 18-24 months, knowing I could choose to stop at any time. Given my limited prior experience of n = 1 child, I figured my son would be the one to wean himself. At least this time I was emotionally prepared for this expectation. Though when 24 months flew by and he was still nursing twice a day, I entertained the possibility that I was just going to be one of those rare toddler-nursing moms. Since nursing typically only occurred at morning and bedtime, it wasn’t really any matter of inconvenience for me, so I happily continued to soak up the intimacy.

A few months later, my older son’s anxiety diagnosis was upgraded to autism and ADHD, and as many parents have done so before me, I began to reflect on whether I also have autism and ADHD. Since I’m female, the autism diagnosis is pretty tricky, and a topic for a different story. But I did ask my provider, who manages my anxiety/depression treatment, about evaluating me for inattentive ADHD. A few discussions and questionnaires later, my provider conveyed I would likely benefit from a low dose stimulant, and was ready to write me a prescription — until I reminded her I was actually still nursing my toddler twice a day. We briefly recapped my difficulties with executive functioning and self-image, then my provider praised me for my breastfeeding journey, and implied that it might be worthwhile to address my own needs now. I left the consultation with a plan to think about the decision with my family, and that I would likely choose to stop nursing in order to begin treatment for ADHD.

I had waited months to receive my ADHD diagnosis and attended my most recent psychiatry appointment convinced that medicinal treatment would be worthwhile to help me function. To confound the situation more, we’re still in the midst of the COVID-19 crisis, and working full time at home while schooling and caring for children is unsustainable. The lack of day-to-day structure leaves me lost, and while I haven’t felt anxious or the need to be perfect in a long time, I’ve certainly had quite a bit of depression.

Funnily enough, my lifelong anxiety and tendency for depression may in fact be a symptom of my ADHD. ADHD may be the reason why I have always struggled to read; especially in public, without silence, with a looming deadline, during a high-stakes test, or for any task that is not interesting to me. In high school and college, assignments took me too long. I barely had enough time to finish my assigned reading, but I assumed that was normal. I always used all allotted time for exams, but didn’t consider it as unusual, because I typically fared well in grades. I thought college was supposed to be grueling. In graduate school and beyond, I’ve repeatedly struggled with the concern of not working enough, despite my advisors and supervisors giving high praise for my level and quality of productivity. These mixed perspectives leave me feeling confused about how efficient and smart I truly am.

Now after months of home life during COVID-19, I’m noticing even more demoralizing patterns in my thoughts and behaviors. I’ve started forgetting or misplacing my wallet, keys and phone; historically very uncharacteristic of me. I frequently forget an idea, intention or next-step mere moments after fruition. Others have noted their confusion when I have zero recollection of a prior conversation. I’m rarely on time. I get bored of conversations even more quickly than before. All of the above make it difficult for me to function in day-to-day work and parenting tasks.

As for nursing, I know my toddler isn’t getting any nutritional value anymore and perhaps not even the immunity boost; the volume seems negligible. I’m probably just a giant human pacifier at this point. And maybe it’s hormonal, but for a few days of each month nursing is actually really uncomfortable. Now that I better understand my high sensitivity to touch, I also wonder whether nursing isn’t supposed to feel as cringy as it sometimes does. Lately, especially during COVID-19 when the little one has access to me during all hours, he more frequently paws at my shirt, and attempts to lift or stretch while asking for “milk please mama!” This has happened during more than one webcasting meeting. I know there are many new ways he and I can and will ultimately discover to intimately bond, in place of nursing. So given all logical signs outlined above, it would seem it’s an appropriate time to wean and try medicating my ADHD.

The odd thing is…. I think I’ve decided to wait. I know it doesn’t make much sense, but it just feels right. I can stop nursing and start medication at any time; I cannot do the reverse. Similar to there being many ways to intimately bond with an infant or toddler besides breastfeeding, there are many ways I can try treating ADHD before introducing an exogenous stimulant. In my effort to frame the decision of whether to breastfeed or medicate, I’ve realized I only assume medication will help me, but my nursing relationship with my son already helps me. There is no one avenue to my self-care, and perhaps setting a goal to meet my toddler’s needs will prime my efforts and accountability in other areas.

Image of author joyfully multitasking: breastfeeding while working

Originally published: October 6, 2020
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