Safety of Antidepressants in Pregnancy and Breastfeeding
Depression and anxiety disorders are common during pregnancy, affecting nearly one in every five women. Perinatal depression (depression during pregnancy or after the baby’s birth) can be very serious for both mother and baby and it is therefore important that mothers receive treatment. If depression is not treated, it can make it hard for mothers to care for their own and their baby’s needs and may make forming emotional bonds difficult.
Women who stop taking antidepressants just before they become pregnant, or early in pregnancy, have a higher chance of relapsing into depression by the time they give birth.
The decision about how best to treat depression/anxiety in pregnancy is an individual one. We recommend a detailed discussion with your family doctor (GP) who may also recommend psychological support services.Your midwife will also be able to advise you where to access support. This is sometimes through our maternal mental health antenatal clinic or directly through the specialist community perinatal mental health team. Overall it is thought that the risks of not treating depression/anxiety outweigh the risks of antidepressants to both mother and baby.
Can my antidepressant medication harm my baby?
What we understand about the risks to babies of mums who have taken antidepressants when pregnant/breastfeeding is based mostly on observational studies rather than experimental assessment. Therefore, it is hard to be certain if outcomes result from the medicines themselves or other factors in people’s lives. The information provided is based on the best evidence we have.
Antidepressants do pass through the placenta to the baby and studies looking at the risk of congenital heart problems have been reassuring in that the associations between the use of antidepressants and the risks of congenital heart defects in the baby are hard to find when other life factors are taken into account. There is no evidence that antidepressants increase rates of miscarriage, preterm birth or low birth weight. However there is evidence that untreated depression and anxiety can increase risks of preterm birth and caesarean section.
Around one in every three babies born to mothers on antidepressants, will have mild symptoms which can include jitteriness, poor feeding, agitation and fast breathing. These symptoms usually disappear without the need for any treatment, within the first two weeks. There is also a slightly increased risk to these babies of a condition known as Persistent Pulmonary Hypertension of the Newborn (PPHN). PPHN is a very rare but potentially very serious problem causing breathing difficulties in the newborn. The rate of PPHN in mothers who are not being treated with antidepressants is about two per 1000 and this increases to about three per 1,000 in women who take antidepressants. However, these effects are less significant when other life factors are taken into account suggesting that the antidepressants themselves are not the cause.
In order to exclude PPHN and to monitor any symptoms, we recommend that babies born to mothers who have been taking antidepressants in pregnancy are observed with their mothers on the postnatal ward for a minimum of 24 hours following delivery.
Can I breastfeed while taking antidepressants?
If you have been taking an antidepressant while you are pregnant, you should usually be able to continue on the same medication as the amount in breast milk is much less than the baby would have got while you were pregnant. There is evidence to suggest that antidepressant use while breastfeeding is not harmful in terms of the baby’s developmental milestones and preschool performance.
Overall, breastfeeding in women who are taking antidepressants is generally considered to be safe, although there are exceptions and it is therefore important to discuss what medication you are taking with your midwife during your pregnancy in order to have a clear plan in place for the delivery. Your midwife may recommend a referal to the Infant Feeding Specialist Midwife for advice. If your baby is born prematurely or has any health problems it may not be advisable for you to breastfeed if you are taking antidepressants. This can be discussed with your paediatrician.
Where should I give birth if I am taking antidepressants?
As it is recommended that babies born to mothers who have been taking antidepressants during pregnancy are observed on the postnatal ward for a minimum of 24 hours following delivery, we would recommend delivery at Southmead Maternity Unit (Southmead Hospital): either in the Mendip Birth Centre or on the Central Delivery Suite.
List of Psychological Support Services
Wellbeing Therapies: Based at Southmead Hospital and outreach community groups, Self-referral
Anxiety UK: Anxiety UK works to relieve and support those living with anxiety disorders by providing information, support and understanding via an extensive range of services, including 1:1 therapy. We work regularly with external agencies and healthcare professionals to improve services for those living with anxiety disorders
Depression Alliance: Information and self-help groups
Mothers for Mothers: Perinatal depression support group for Bristol, North Somerset, South Glos.
Bluebell: Perinatal depression support group
The Association for Post Natal Illness (APNI): Provides information on postnatal depression. APNI will put affected mothers in touch with other others who have had experience of postnatal depression.
National Phobics Society: Helpline for people who experience anxiety, phobias, panic attacks, phobias and compulsive disorders.
No Panic: Helpline for people who experience anxiety, panic attacks, phobias or compulsive disorders.