Antidepressants

Antidepressants during pregnancy and breastfeeding

This page covers: 

• What are the risks and benefits of taking antidepressants while pregnant or breastfeeding?
• What can I do to feel more in control? 
• Further support during pregnancy and breastfeeding

“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. 
• 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.

• All pregnancy-related risks are likely to be higher when taking antidepressants during the  first three months or last few weeks of your pregnancy. 
• 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 (Sinequan). 
• 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 developed 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 treatment 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 potential risks. For example, you may be able to manage your symptoms more 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. 

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. It can help to talk through your feelings with someone you trust, such as a partner or close friend. 
• Midwife appointments. If you are under the care of a midwife, you can talk to them 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. 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. 
• Specialist organisations. Hong Kong organizations:
  – Hospital Authority Mental Health Direct (24 Hours) 2466 7350
  -The Samaritan Befrienders Hong Kong (Chinese hotline) 2389 2222
  -The Samaritans (Multilingual hotline): 2896 0000
  -Family Health Service Breastfeeding Hotline 3618 7450
  – Other breastfeeding hotlines
  – Family Planning Association of Hong Kong

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.