Expecting a baby is an emotional time for anyone, but it can be particularly tough if you experience a mental health problem like depression or anxiety.
You might already be taking antidepressants when you become pregnant, or you might be offered antidepressants to treat a problem you develop during your pregnancy, or after giving birth, such as postnatal depression (PND).
Ultimately, you will need to balance the possible risks to your baby against any potential harm in not taking your medication, and come to your own decision about what's best for you, based on your own experience.
It's understandable to feel conflicted about this, and you might find it helpful to seek extra support.
I developed severe postnatal depression and OCD just 3 days after the birth of my daughter. I was non-functioning, I couldn't even leave the house and was suicidal... [my antidepressant] really helped, and gave me the crutch I needed to function again. I really feel like it saved my life.
What are the risks?
The risks include:
- Possible birth defects. There is evidence that taking SSRIs early in pregnancy slightly increases the risk of your baby developing heart defects, spina bifida, cleft palate and hare lip.
- Increased risk of miscarriage and premature birth.
- Withdrawal symptoms in the newborn baby. Taking any antidepressant in late pregnancy (including tricyclics, SSRIs and SNRIs) carries this risk. Withdrawal symptoms in a newborn include:
- with tricyclics: fast heartbeat, irritability, muscle spasms, restlessness, sleeplessness, fever and fits.
- with SSRIs and SNRIs: jitteriness, poor muscle tone, not being able to cry loudly, difficulty breathing, low blood sugar (which can cause fits), and high blood pressure in the lungs.
- When breastfeeding, the drug could be passed to your baby through your breast milk. It is possible that the levels could become high enough for your baby to experience side effects from the medication.
- Unknown risks. Drugs are not clinically tested in pregnant women, and newer drugs carry a higher unknown risk than drugs that have been around longer, simply because scientists have had less time to gather evidence about them.
All risks are likely to be higher during the first 3 months and last few weeks of your pregnancy, when your baby is more vulnerable.
Advantages of breastfeeding
Evidence shows that there are a number of advantages to breastfeeding your baby for at least part of the time, such as:
- better nutrition for your baby (breast milk contains beneficial fats)
- better immunity for your baby against various illnesses
- more close bonding opportunities for you and your baby
You might feel that these advantages outweigh the risks.
If you do decide to breastfeed your baby while taking antidepressants you should discuss your choice of medication with your doctor, as some drugs are more safe when breastfeeding than others.
What if I need to take medication?
If you feel it’s necessary for your wellbeing to take antidepressants while pregnant or breastfeeding, you should discuss your choice of medication with your doctor. They can advise you on which drugs carry fewer risks than others. For example:
- Tricyclic antidepressants are likely to be less risky in the early months of pregnancy.
- If you wish to breastfeed, you should avoid taking doxepin (Sinepin).
If you have experienced a mental health problem in the past, you might also have a higher risk of experiencing postnatal depression (PND) after you give birth. If you're worried that you might experience PND it's worth discussing it with your doctor and midwife in advance, to make sure you have appropriate support in place.
I was so against medication long term. Then when I got pregnant I was terrified of not being able to look after a child in the mental state I was in. I couldn't do therapy. So I tried the pills. It took a few different types till I found ones that were right for me, but I couldn't function anywhere near as well till I had them.
What are the alternatives to medication?
There are a number of alternatives to antidepressants available.
If you don't want to take medication while pregnant or breastfeeding, your doctor should make every effort to help you access alternative treatments. With the right support, you might be able to manage your mental health without medication.
(See our information on coming off psychiatric drugs for guidance on how to come off your medication safely.)
What other support is available?
Coming to a decision you feel comfortable with about what's right for you and your baby can be difficult. You might find it helpful to explore these options for extra support:
- Family and friends – if you're able, it can be helpful to talk through your feelings with someone you trust, such as your partner, or a close friend.
- Midwife appointments – you can talk to your midwife about how you're feeling throughout your pregnancy. They can also help make sure you receive plenty of support from your health visitor after you give birth.
- Online peer support – websites such as Netmums and Mumsnet offer a supportive online network for all parents and parents-to-be. It can be helpful talk to other people who've had similar experiences themselves, who can reassure you that you're not alone. Elefriends is another online community where you can share your feelings about your mental health in a supportive environment. (For guidance on how to manage being online when you're feeling vulnerable, see our information on how to stay safe online.)
- Specialist websites – websites such as NCT and the Breastfeeding network can also provide information and support.
You might also find it helpful to read our pages on how to cope as a parent with a mental health problem, which include information on helping yourself, looking after children, and other kinds of support available.
This information was published in 2014. We will revise it in 2016.