Antidepressants in pregnancy

If you are taking antidepressants and planning a pregnancy or become pregnant, talk to your doctor about whether it would be best for you to gradually stop taking them, switch to another type that is safer in pregnancy or continue with the one you are taking.

Key points

  1. Every woman's experience of depression before or during pregnancy is unique and will affect whether you continue to take antidepressants during pregnancy
  2. Antidepressants are effective for moderate to severe depression, but other options are best for mild depression.
  3. Psychological treatments such as cognitive behaviour therapy (CBT) and talking therapy work better for mild depression.
  4. To improve the symptoms of depression, antidepressants are most effective when used together with psychological therapies and lifestyle changes. Read more about depression and antidepressants.

What do I need to know if I am planning a pregnancy or become pregnant

If you are planning a pregnancy or become pregnant while you are taking antidepressants, it is very important to talk with your doctor about the pros and cons of staying on or coming off your antidepressant medication. The decision about whether to take antidepressants while you are pregnant depends a lot on how severe your symptoms are. Together with your doctor, you can compare the risks of taking the medicine with the risks of living with and managing your symptoms. If you are taking antidepressants and are planning to become pregnant, some options are:

  • Continuing with your antidepressant if it is safe to take during pregnancy
  • OR Switching to an antidepressant that is safer in pregnancy
  • OR trying a slow, gradual withdrawal of the antidepressant with the help of your doctor.

If medicine withdrawal is not possible for your stage of the illness, you may want to consider delaying the pregnancy until treatment is no longer required.

What are the potential risks of taking antidepressants while you are pregnant?

All antidepressants carry some risks. Some antidepressants are much less likely to harm your baby than others. Some antidepressants may increase the risk of mild effects in the newborn such as a slightly lower weight at birth, mild breathing problems, irritability, and feeding problems. Some antidepressants may increase the risk of certain birth defects, or pre-term birth (baby is born before its expected date). If you are taking antidepressants during your pregnancy, your newborn may need to stay in hospital for an extra few days, so that doctors and midwives can watch for any signs that the medication is affecting your baby. Read more about the risks and benefits of taking medicines for mood, epilepsy or pain.

Lithium: if you are on lithium therapy, this should always be managed by a maternity mental health team during pregnancy.

Sodium valproate: if you are a woman of child-bearing age and could possibly get pregnant, you should avoid valproate, if possible. If you use it during pregnancy, there is a risk of harm to your unborn baby, as well as long-term developmental disorders once they are born. If valproate is the best choice for you despite this, it’s important you understand the risks. Talk to your doctor about this and ensuring you have effective contraception so you avoid unplanned pregnancy. 

What are the risks of not taking antidepressants?

If depression is not treated during pregnancy, and you have a relapse, it can harm both mother and child. If you don't treat your depression:

  • You may not eat well or get enough sleep.
  • You may smoke and drink.
  • You may not go to the doctor as often as you should.
  • You may deliver early and have a baby that weighs less than it should.
  • You may also be more likely to have postnatal depression after the birth. Postnatal depression may make it hard to care for and bond with your baby. 

Do NOT suddenly stop your antidepressant if you find you are pregnant as relapse rates are high. 68% of women with a history of depression who discontinue medication during pregnancy find their depression comes back.  

Learn more

Antidepressants NHS Choices
Depression: Should I take antidepressants while I'm pregnant?  Myhealth.Alberta
Myths about taking antidepressants Mothers Helpers NZ
Are you taking medicines for epilepsy, mood or pain? ACC, New Zealand 

References

  1. The role of medicines in the management of depression in primary care BPAC, NZ 2017
  2. SAFERX Bulletins: Antidepressants in pregnancy & breastfeeding - deliver safe choices Waitematā District Health Board. July 2012
  3. The use of antidepressants in pregnancy Medsafe NZ, 2010
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 20 Nov 2019