Antidepressants in pregnancy

If you are taking antidepressants and planning a pregnancy or get pregnant, talk to your doctor.

Key points

  1. You will need to decide whether it would be best for you to gradually stop taking antidepressants, switch to another type that is safer in pregnancy or continue with the one you are taking.
  2. Every woman's experience of depression before or during pregnancy is unique and will affect whether you continue to take them during pregnancy
  3. All antidepressants carry some risks. Some antidepressants are much less likely to harm your baby than others.
  4. However, if depression is not treated during pregnancy, and you have a relapse, it can harm both you and your child.
  5. Your doctor can help you work out the best thing to do for your situation.

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, you need 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 to:

  • continue with your antidepressant if it is safe to take it during pregnancy
  • switch to an antidepressant that is safer in pregnancy
  • try a slow, gradual withdrawal of the antidepressant with the help of your doctor.

If coming off antidepressants is not possible at the moment, you may want to think about delaying the pregnancy until you no longer need treatment.

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 a 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 your baby being 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 childbearing 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, you need to understand the risks. Talk to your doctor about this and how to make sure you have effective contraception so you avoid an 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 you and your child. If you don't treat your depression you may:

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

Do NOT suddenly stop your antidepressant if you find you are pregnant. Most women with a history of depression who stop taking medication during pregnancy find their depression comes back.  

Learn more

Antidepressants NHS, UK
Depression – should I take antidepressants while I'm pregnant? My Health, Alberta, Canada
Myths about taking antidepressants Mothers Helpers, NZ
Are you taking medicines for epilepsy, mood or pain? ACC, NZ 

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, NZ, 2012
  3. The use of antidepressants in pregnancy Medsafe NZ, 2010
Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland, Dr Jeremy Steinberg, FRNZCGP Last reviewed: 20 Nov 2019