In this episode of Behind the Latch, Margaret Salty interviews Dr. Ariana Komaroff, family nurse practitioner and lactation specialist, about her published case report detailing breastfeeding care for a patient with bipolar disorder. Together, they explore how mental health conditions intersect with lactation goals, the challenges of medication management, the importance of collaborative care, and what lactation professionals can do to support families with complex psychiatric histories.

Dr. Komaroff’s Journey into Lactation

Ariana shares how her early career as a NICU nurse opened her eyes to the emotional needs of families:

• Initially focused on infant care, she quickly realized how much parents struggle emotionally in the NICU
• Wanted to provide better support for families—especially with milk production and feeding
• Became a nurse practitioner to care for both parents and infants
• Is now in private practice, academic teaching, and pediatric primary care

The Case Study: Bipolar Disorder and Lactation

Dr. Komaroff details the real-life case that inspired her publication:

• A mother with bipolar disorder on aripiprazole (Abilify) could not lactate postpartum due to medication-induced prolactin suppression
• The experience was traumatic for the mother, who felt betrayed and unsupported
• Two years later, she returned during a second pregnancy, determined to breastfeed
• She was now on a new medication regimen (lithium, lorazidone, lamotrigine)

Balancing Mental Health and Lactation Goals

The case highlights critical decision points:

• Lithium poses risks to infant kidney and thyroid function and requires close monitoring if used during lactation
• Shared decision-making with the patient, psychiatrist, therapist, and pediatrician was essential
• The patient ultimately chose to wean off lithium before delivery while increasing lamotrigine with psychiatric support
• Supportive care included increased talk therapy and close lactation follow-up

The Importance of Sleep in Perinatal Mental Health

Dr. Komaroff emphasizes that:

• Sleep deprivation is a key risk factor for postpartum psychosis and mood destabilization in bipolar patients
• A consolidated 4–5 hour stretch of sleep was prioritized postpartum, with support from the partner
• Expressed milk, donor milk, or formula were considered based on supply to support overnight rest

Breastfeeding Success and Weaning

The patient:

• Successfully breastfed for five months, then chose to wean gradually after returning to work
• Felt empowered to make her own decision around weaning—an experience completely different from her first birth
• Did not experience mood destabilization or regret, thanks to the slow and supported process

Key Lessons for Lactation Professionals

Dr. Komaroff and Margaret highlight important takeaways:

• Listen deeply and individualize care—there’s never a one-size-fits-all plan
• Include psychiatrists, therapists, pediatricians, and family in care planning
• Use tools like the MDQ (Mood Disorder Questionnaire) or GAD-7 when appropriate
• Recognize the power of shared decision-making in improving outcomes
• Encourage others to publish unique cases to expand the evidence base

Guest Info:

Dr. Ariana Komaroff, DNP, FNP, IBCLC, is a clinician and educator practicing in Westchester, NY and Southern Connecticut. She teaches at Columbia University School of Nursing and specializes in family-centered lactation care across the perinatal spectrum.

Resources Mentioned in This Episode:

📌 Clinical Lactation – Journal that published Dr. Komaroff’s case study

📌 Postpartum Support International (PSI) – postpartum.net

📌 Infant Risk Center – infantrisk.com

📌 MotherToBaby – mothertobaby.org

📌 LactMed – NIH’s database on medication and breast milk

📌 Edinburgh Postnatal Depression Scale, MDQ, GAD-7 – Screening tools for mood and anxiety

Connect with Me:

Have questions or ideas for future episodes? Reach out!

📧 Email: [email protected]

📸 Instagram: @margaretsalty

📘 Facebook: Margaret Salty’s IBCLC Community

Credits:

🎙 Hosted by: Margaret Salty

🎧 Guest: Dr. Ariana Komaroff

🎵 Music by: The Magnifiers, My Time Traveling Machine

Hashtags & Keywords:

#BehindTheLatch #BipolarDisorderAndBreastfeeding #PerinatalMentalHealth #SharedDecisionMaking #LactationSupport #TripleFeeding #LactationCaseStudy #BreastfeedingWithMedication

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