Postpartum Distress in Women With ADHD: Risks, Recognition, and Evidence-Based Management

This article explores the challenges of postpartum distress in women with attention-deficit/hyperactivity disorder (ADHD), highlighting how symptoms and psychiatric comorbidities can intensify during pregnancy and the postpartum period. It reviews current evidence, treatment considerations, and strategies to support maternal mental health and infant well-being.

Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurodevelopmental disorder involving impaired attention, executive functioning, and/or impulse control. ADHD affects 3% to 7% of children and persists into adulthood in approximately 75% of females diagnosed in childhood.¹ The estimated prevalence of ADHD among adult women is 3.2%, although only approximately 10% of adults receive treatment.¹ ADHD symptoms often intensify during pregnancy and postpartum as the demands of child rearing increase; these demands may be particularly burdensome for mothers already experiencing impaired attention and executive dysfunction.¹ 

Despite these added challenges, many pregnant women with ADHD are advised to discontinue their ADHD medication, especially if they are also taking other psychiatric treatments.¹ A Danish registry study evaluated perinatal ADHD medication patterns in 4052 women (4717 pregnancies).² Only 23.3% of women in the study continued ADHD medication before, during, and after pregnancy, with methylphenidate being the most frequently used medication (89.1%). A larger proportion (41.8%) discontinued medication entirely, while 17.2% paused or reduced use during pregnancy and resumed postpartum. The authors suggested that discontinuing medication during pregnancy and postpartum may reflect a motivation to minimize fetal exposure and infant exposure through breast milk.² 

The Importance of Taking ADHD Medication During and After Pregnancy 

Low or inconsistent ADHD medication use in the perinatal period leaves many mothers at risk. In addition to intensified ADHD symptoms, the disorder frequently co-occurs with other psychiatric conditions.¹ A large electronic health records registry was used to evaluate psychiatric comorbidities in 13 588 women with ADHD compared with 474 798 women without ADHD.³ Compared with women without ADHD, the study showed women with ADHD had higher rates of depression, obsessive-compulsive disorder, and stress-related disorders at both 6 weeks and 12 months postpartum. After adjustment, the relative risk (RR) of any mood disorder remained significantly elevated: 1.14 at 6 weeks and 1.22 at 12 months postpartum.³ Notably, pregnant and postpartum individuals with ADHD may be more likely than women without ADHD to visit psychiatric providers, which increases the likelihood of being screened for depression and anxiety disorders postpartum if they emerge.⁴ 

Addressing the underlying ADHD is critical to effectively managing psychiatric comorbidities. Treating this depression or anxiety alone is often insufficient without addressing underlying ADHD, as treatment of depression and anxiety is seldom successful if ADHD remains untreated.¹ Untreated ADHD also increases the risk of spontaneous abortion and preterm birth.¹ Depressive symptoms may worsen when stimulant treatment is discontinued during pregnancy,¹ and the continued presence of maternal depression may increase the risk of offspring ADHD.⁵

ADHD Medication Use During Breastfeeding

Treatment of ADHD in the perinatal period can be continued, albeit with caution. Available evidence, though limited, suggests that amphetamines or methylphenidate administered at therapeutic doses during breastfeeding have not been associated with clinically significant adverse effects in infants.¹ Both medications are excreted into breast milk and can be detected in infant serum; however, methylphenidate levels are generally lower than those of amphetamines.

Rules of Thumb

General principles can guide the management of ADHD during pregnancy and lactation. During pregnancy, patients on psychostimulants should have a risk-benefit discussion about continuing or using medication intermittently, with close monitoring of fetal growth, maternal blood pressure, and weight gain.¹ Postpartum, therapeutic doses of methylphenidate or bupropion may be continued during breastfeeding, while amphetamine derivatives require discussion of safety.¹ Strategies such as intermittent dosing and timing feeds to reduce infant exposure may be considered.¹ Careful, individualized management of ADHD and comorbid mood disturbances can help balance maternal well-being and the safety of the child during the perinatal period, optimizing maternal functioning and infant well-being.

References:

1. Scoten O, Tabi K, Paquette V, et al. Attention-deficit/hyperactivity disorder in pregnancy and the postpartum period. Am J Obstet Gynecol. 2024;231(1):19-35. doi:10.1016/j.ajog.2024.02.297
2. Bang Madsen K, Bliddal M, Borg Skoglund C, et al. Attention-deficit/hyperactivity disorder (ADHD) medication use trajectories among women in the perinatal period. CNS Drugs. 2024;38(4):303-314. doi:10.1007/s40263-024-01076-1
3. Babinski DE, Riggle K, Tuan WJ. Postpartum distress among women with and without attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2025;86(3):24m15724. doi:10.4088/JCP.24m15724
4. Andersson A, Garcia-Argibay M, Viktorin A, et al. Depression and anxiety disorders during the postpartum period in women diagnosed with attention-deficit/hyperactivity disorder. J Affect Disord. 2023;325:817-823. doi:10.1016/j.jad.2023.01.069
5. Tusa BS, Alati R, Ayano G, Betts K, Weldesenbet AB, Dachew B. The risk of attention-deficit/hyperactivity disorder symptoms in offspring of mothers with perinatal depression: a systematic review and meta-analysis. Asian J Psychiatr. 2024;102:104261. doi:10.1016/j.ajp.2024.104261