Acute Onset or Worsening of Psychiatric Symptoms Following Breastfeeding Cessation: An Illustrative Case and Literature Review.

Abstract

Background: Breastfeeding shares a complex, occasionally contradictory relationship with maternal mental health. Both positive and negative mood impacts have been noted in relation to breastfeeding initiation as well as cessation. Though popular magazines and online forums discuss the onset of psychiatric symptoms following weaning, there is limited medical literature detailing this relationship.

Methods: We describe the case of a patient who developed psychiatric symptoms shortly after weaning, including acute-onset insomnia and worsening anxiety. A literature review of psychiatric symptom development following breastfeeding cessation was conducted using the search engines PubMed, PsycINFO (EBSCOhost), and Embase. Search terms included controlled vocabulary, keywords (within title and abstract fields), synonyms, and related concepts for: postpartum period, postpartum depression, postpartum anxiety, breastfeeding cessation, breastfeeding weaning, lactation, dysphoric milk ejection reflex, and insomnia. Relevant case reports were reviewed and compared to this case. Information including the patient's age, psychiatric symptoms, past psychiatric history, medical work-up, treatment, and outcome was extracted from each article.

Results: Nine patients who developed psychiatric symptoms following breastfeeding cessation were identified in six case reports. Three patients experienced recurrent symptoms in multiple pregnancies. This led to documentation of 13 discrete post-weaning syndromes. All cases involved either first-time parents, those new to breastfeeding, or those experiencing symptoms during multiple weaning periods. Table 1 synthesizes data from article review. As with our case, 11 clinical cases describe sleep changes (primarily insomnia) and 4 discuss anxiety symptoms. Treatment varied based upon symptoms experienced, with no consistently effective treatments identified across cases.

Conclusions: This case of unspecified insomnia and anxiety disorders following abrupt weaning adds to the limited literature in the field and suggests that physiologic and psychologic factors associated with breastfeeding cessation may play a role in the development or worsening of postpartum mood disorders. Intensive psychiatric treatment resulted in resolution of the patient's symptoms. The relationship between weaning and psychiatric disorders is evident in the lay press but is underrepresented in medical literature. Additional research is needed to better understand this relationship so that physicians can counsel, diagnose, and treat patients more effectively.