Antidepressants during pregnancy and breastfeeding: what a mother should know

Are antidepressants during pregnancy safe? The short answer

Antidepressants during pregnancy, and psychiatric medicines in general, are not always off-limits. Some are used in pregnancy when needed, after the doctor has weighed their benefits and risks; others need changing or extra caution. Just as important, untreated mental illness carries its own risks for the mother and the baby, so the right decision is not always to "stop everything".

The US Centers for Disease Control and Prevention (CDC) explains that many pregnant women need medicines to treat ongoing health conditions, and that stopping a necessary medicine can, in some cases, be riskier than continuing it. That is why the first step is always to talk to your doctor before changing anything.

This article helps you understand how doctors think about this decision and what to ask at your appointment, but it does not replace the advice of your own doctor, who knows your condition and history.

Why untreated depression or psychosis in pregnancy is a risk in itself

Pregnancy does not protect you from mental illness. The NHS notes that depression and anxiety can start during pregnancy, or come back in women who have had them before. The UK's Royal College of Psychiatrists adds that the risk is higher for women with bipolar disorder, psychosis or severe depression.

A scientific review published in Interdisciplinary Toxicology in 2017 reports that untreated depression during pregnancy is linked to problems for both mother and child, including:

• A higher risk of pre-eclampsia.
• A greater chance of postnatal depression and difficulty bonding between mother and baby.
• A higher risk of suicidal thoughts in the mother.
• Lower birth weight, a greater chance of premature birth, and a more irritable baby.

The US National Institute of Mental Health (NIMH) adds that depression during and after pregnancy can have a serious effect on the health of both mother and baby, and stresses that treating perinatal depression is very important for both of them. So treatment, in whatever form suits you, is a way of protecting you and your baby.

You've found out you're pregnant while on a psychiatric medicine: what now?

Many mothers stop their medicine out of fear for the baby, and that feeling is completely understandable. But the Royal College of Psychiatrists explains that stopping some medicines, especially suddenly, can bring symptoms back, and that any change should be made with your specialist's support. What to do right now:

1. Keep taking your medicine as it is until you've spoken to your doctor.
2. Book an appointment with your psychiatrist soon, and tell your obstetrician that you take a psychiatric medicine.
3. Write down every medicine and supplement you take, and when you started each one.
4. Ask: is this medicine suitable to continue? Is there a better alternative? What follow-up do I need during pregnancy and after birth?

The CDC also warns against relying on the "safe medicines" lists that circulate online, because many of them are not based on strong evidence. Treat them as a starting point for a conversation with your doctor, not a substitute for one.

How does the doctor weigh the benefits and risks of each medicine?

There is no single rule for every medicine or every mother. According to the Royal College of Psychiatrists, the decision depends on several things:

• Your history: how many episodes you've had and how severe they were, and whether you relapsed when you stopped medicine in the past.
• Which medicines have helped you before, and what side effects they caused.
• How likely you are to become unwell during pregnancy or after birth if your treatment changes.
• What research says about this particular medicine and its possible effects on the baby.

Do antidepressants affect pregnancy?

NIMH states that the risk of birth defects linked to antidepressants during pregnancy is very low. Even so, the 2017 review mentioned above notes that taking some antidepressants in late pregnancy may be linked to temporary symptoms in the newborn during the first days, such as irritability or difficulty feeding or breathing. This is why the NHS, for example in its page on sertraline, says it is usually recommended to give birth in hospital so that mother and baby can be watched closely. The evidence on some long-term effects remains unsettled, and this is something your doctor will discuss openly with you.

Medicines that need special caution

Some mood stabilizers, such as valproate, carry serious risks for the unborn baby. According to guidance from the UK Medicines and Healthcare products Regulatory Agency (MHRA), updated in 2025, about 11 in every 100 babies exposed to valproate during pregnancy have a birth defect, and between 3 and 4 in every 10 children may have problems with development and learning. Yet the same guidance is clear: do not stop this medicine without talking to your specialist, and contact them straight away if you are planning a pregnancy or think you may be pregnant. As for antipsychotics, the Royal College of Psychiatrists says large studies have not found an overall increase in birth defects with them, although blood sugar needs to be checked more regularly during pregnancy.

To learn more about the types of psychiatric medicine and how they work, read our guide to psychiatric medicines.

Planning pregnancy on psychiatric medication

The best time to make decisions about medicine is before pregnancy, when there is time to adjust treatment calmly and make sure you stay stable. The CDC advises reviewing your medicines with your doctor when you are thinking about pregnancy and making a plan for treating your health condition beforehand. The Royal College of Psychiatrists likewise recommends talking to your psychiatrist before trying to conceive, to decide whether your medicine should continue or change.

• Tell your psychiatrist that you want to get pregnant, months ahead if you can.
• Make sure your obstetrician knows about your condition and medicines, so the two doctors can work together.
• Discuss suitable contraception until the plan is in place, especially if you take a medicine that needs special caution.
• Agree with your doctor on the warning signs of a relapse and what to do if they appear.

Can psychiatric medication affect your periods?

Some antipsychotics can raise the milk hormone, prolactin. Cleveland Clinic notes that high prolactin can cause irregular or missed periods and may be linked to difficulty getting pregnant. The Royal College of Psychiatrists explains that checking this hormone is useful if pregnancy is delayed, and that the doctor may switch to a medicine with less effect on it. If you notice changes in your cycle, tell your doctor, and don't change your medicine on your own.

Psychiatric medication and breastfeeding: how is the decision made?

The breastfeeding question is answered case by case. The NHS says antidepressants are often safe to take while breastfeeding, and its sertraline page explains that sertraline passes into breast milk in small amounts and that side effects in the baby are rare. The Royal College of Psychiatrists explains that all antipsychotics pass into breast milk, usually in small amounts, but with some of them breastfeeding is not recommended.

So the decision depends on the specific medicine, and breastfeeding is usually encouraged when the benefit of the medicine to you outweighs any possible risk to your baby. If you are worried about any change in your baby while breastfeeding, tell your doctor. The Royal College also reminds mothers that bottle feeding allows a strong bond between mother and baby too, and that sharing a bed with the baby should be avoided, especially with medicines that cause drowsiness. Breastfeeding is an important choice, but your mental health is part of your baby's health.

After birth: the most sensitive time, and signs to watch for

Mood swings and tearfulness in the first days after birth are common and usually pass within about two weeks. If the symptoms last or get worse, it may be postpartum depression, which, according to the NHS, can start at any time in the first year. Watch for these signs:

• Ongoing sadness or emptiness, and losing interest in things you used to enjoy.
• Intense anxiety, or guilt and a feeling that you are a "bad mother".
• Trouble sleeping even when the baby sleeps, or trouble concentrating.
• Difficulty bonding with the baby, or constant fear and worry.
• Thoughts of harming yourself or the baby: the NHS and NIMH list them among the signs of postpartum depression, a condition that can be treated. These thoughts are frightening, and talking about them is nothing to be ashamed of; it is the right step. Tell your doctor about them soon, and don't wait for your next appointment. If you have thoughts of ending your life, a plan or intention to act on these thoughts, or you feel you can't keep yourself or your baby safe, get help immediately, as described in the box below.

There is also a rare but serious condition called postpartum psychosis. The Royal College of Psychiatrists (2018) estimates that it affects about 1 in every 1,000 women who give birth. It usually starts within the first two weeks after delivery and its symptoms can change quickly, so the College treats it as a psychiatric emergency that needs help the same day, and most women need treatment in hospital. Signs include confusion, hearing or seeing things that aren't there, strange thoughts, and being overactive or having rapid mood changes. The risk is higher for women with bipolar disorder or a previous episode. The College reassures women that a full recovery is usually expected with treatment, even if it can take several months.

Non-medication treatment is a core part of the plan in pregnancy and breastfeeding

Medicine is not the only treatment. The NHS says depression and anxiety in pregnancy often improve with talking therapies such as cognitive behavioral therapy, and NIMH adds interpersonal therapy to the proven treatments for depression during and after pregnancy. Your doctor will decide, based on your situation, whether talking therapy is enough or whether medicine should be added.

• Rest and sleep as much as you can, for example by agreeing with your husband or a family member to share the baby's care.
• Family support: accept help at home and with the baby, and talk about your feelings with someone you trust, as the NHS recommends.
• Regular follow-up with your doctor, even when you feel better.

How treatment works in practice, and when to see a doctor

See a psychiatrist if you are thinking about pregnancy and take a psychiatric medicine, if you have just found out you're pregnant, or if you develop symptoms of depression or anxiety during pregnancy or after birth, even if only some of them. At an outpatient appointment the doctor reviews your history and medicines, talks through your options clearly, and coordinates the plan with your obstetrician. Psychotherapy sessions can be added as part of the plan. Appointments and sessions at Oxygen Center are open to women and men aged 15 and over (under 18 with a guardian's consent).

Your decision about medicine is not one you have to make alone, and it is not final. It is a flexible plan that is reviewed at every stage of pregnancy and breastfeeding, with one goal: a healthy mother and a baby growing up in her care.