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Antidepressants

Explains what antidepressants are, how they work, possible side effects and information about withdrawal.

I developed severe postnatal depression and OCD just three 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 and benefits of taking antidepressants while pregnant or breastfeeding?

There are some risks to taking antidepressants during pregnancy or while breastfeeding. These include the following:

  • Possible birth defects. There is evidence that taking SSRIs early in pregnancy slightly increases the risk of your baby developing heart defects, spina bifida or cleft lip.
  • Increased risk of miscarriage and premature birth.
  • Slightly increased risk of blood loss after childbirth. If you take SSRI or SNRI antidepressants in the month before giving birth, there is a small increase in your risk of heavy bleeding in the first 24 hours after birth (known as postpartum haemorrhage).
  • Withdrawal symptoms in your newborn baby. Taking any antidepressant in late pregnancy has the risk that your newborn baby will experience withdrawal symptoms. These symptoms include:
    • 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.
    • With tricyclics: fast heartbeat, irritability, muscle spasms, restlessness, sleeplessness, fever and fits.
  • If you are breastfeeding, antidepressants can 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.
  • If you wish to breastfeed, you should avoid taking doxepin (Sinepin).
  • Drugs are not usually clinically tested on anyone who is pregnant. There is not much evidence around how safe it is to take antidepressants during pregnancy. Newer drugs carry a higher 'unknown' risk than drugs that have been around longer. This is because scientists have had less time to gather evidence about them.

There may also be benefits to taking antidepressants during this time:

  • You might already be taking antidepressants when you become pregnant. You may feel concerned about becoming unwell or unable to cope if you stop taking antidepressants. This may mean you decide that the best thing for you and your baby is to continue taking them, so you are well enough to care for your baby.
  • Or you may be offered antidepressants to help treat a problem you develop during pregnancy or after giving birth, such as postnatal or antenatal depression.

Your doctor can help you balance the possible risks to your baby against the benefits of taking your medication. This is to help you come to your own decision about what's best for you. But it is understandable if you feel unsure about this. You might find it helpful to seek further support during this time.

When I got pregnant I was terrified of not being able to look after a child in the mental state I was in. So I tried [antidepressants]. I couldn't function anywhere near as well till I had them.

What can I do to feel more in control?

Being pregnant can sometimes feel like you’re giving up control of your own body. This can be stressful, but there are lots of positive steps you can take:

  • Planning your pregnancy gives you more options early on. But it is also a common experience to find out you’re pregnant without planning it. Whatever your situation, it’s important to remember that you have the same rights as everyone else. This includes the right to choose whether or not to take medication, and to have your say in decisions about your treatment.
  • Talk to a healthcare professional as early on as you can. This could be with your doctor or midwife, or a mental health specialist. The earlier you start talking to someone about your options, the more in control you're likely to feel. For planned pregnancies, this is as soon as you decide you want to start trying to get pregnant. For unplanned pregnancies, this is as soon as you think you might be pregnant.
  • Seek further support, to talk through your options and decide what's right for you.
  • If you decide to stay on your medication, ask your doctor how you can reduce any risks. For example, you may be able to manage your symptoms effectively on a reduced dose.
  • If you decide to come off your medication, make sure you do it safely. See our pages on coming off medication for more information. Our page on alternatives to antidepressants has information about other treatment and support options for your mental health.

Further support during pregnancy and breastfeeding

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:

  • Talk to someone you trust. If you feel able to, it can help to talk through your feelings with someone like a partner or 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. Our page on talking to your GP has tips on having conversations about your mental health with any medical professional, including your midwife. Your doctor should be in touch with your midwife and antenatal team throughout your pregnancy.
  • Perinatal mental health services. These services offer support to help you stay well during your pregnancy. You can be referred to these services by other professionals involved in your care, such as your doctor.
  • Online peer support. It can be helpful to talk to other people who've had similar experiences to yours. Netmums has a supportive online network for all parents and parents-to-be. You can also talk about your experiences with others on Mind’s supportive online community Side by Side. See our pages on online mental health for information on using the internet if you’re feeling vulnerable.
  • Specialist organisations. Organisations such as NCT and the Breastfeeding Network can also provide information and support on pregnancy, breastfeeding and mental health.

You might also find it helpful to read our pages on parenting with a mental health problem. These pages include information on taking care of yourself, looking after your children, and other kinds of support available to parents. Our information on perinatal mental health problems may also help.

This information was published in September 2020. We will revise it in 2023.

References and bibliography available on request.

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