Antidepressants in pregnancy: what to know, and why not to stop suddenly

If you take an antidepressant and you’ve just found out you’re pregnant, your first instinct might be to stop. Please don’t do that on your own. Whether to carry on, change or stop is a decision to make with your doctor, and there’s good information to help you both.

First: don’t stop suddenly

Stopping an antidepressant suddenly can cause withdrawal symptoms. Bumps says stopping an SSRI might also affect your mental health. The NHS advises telling your doctor or specialist as soon as possible when you find out you’re pregnant, and not stopping your medicine until you’ve spoken to them.

If you and your doctor decide you should come off it, they’ll usually reduce the dose gradually, over several weeks or months.

Who to talk to

Book an appointment with your GP, or contact your psychiatrist or mental health team if you have one. Tell your midwife too. If you haven’t got one yet, see how to refer yourself to a midwife.

Your doctor will talk you through the possible benefits and risks for you and your baby. There’s no single right answer. Depression and anxiety can often be treated with talking therapies such as CBT, sometimes alongside medicine. If you do take an antidepressant in pregnancy, the NHS says you’ll be offered the one that’s safest for you and your baby, at the lowest dose that works.

What bumps says about SSRIs

SSRIs (selective serotonin reuptake inhibitors) include sertraline, citalopram, escitalopram, fluoxetine and paroxetine. Bumps, the UK’s Best Use of Medicines in Pregnancy service, says an SSRI can be used in pregnancy if your doctor recommends it, and that the overall risk to you or your baby is low. In more detail:

Birth defects: some studies have suggested a small increase in heart problems with use in early pregnancy, but most studies don’t support this. If there is an increase, it’s small, and most babies exposed have a normal heart.
Miscarriage, early birth, birth weight and later development: the available evidence doesn’t prove that SSRIs affect these.
Settling in after birth: some babies have short-term withdrawal symptoms, so your baby may be observed for a little while after birth.
Breathing: bumps lists a rare newborn lung condition, persistent pulmonary hypertension of the newborn (PPHN), as a possible complication, but describes the risk as low. Your baby will be checked for any breathing difficulty after birth, just in case.
Bleeding after birth: taking an SSRI in the month before birth may slightly raise the chance of heavier bleeding.

If you’re taking an SSRI later in pregnancy, you’ll usually be advised to give birth in hospital, so you and your baby can be looked after closely. You won’t need extra scans because of an SSRI, beyond the routine 20-week scan.

Bumps also says no SSRI is considered better than the others in pregnancy. The best one is usually the one that works for you, and there’s no good evidence that other types of medicine are safer. It says that if an SSRI is working well, the benefits of continuing are likely to outweigh the risks, but that’s something to weigh up with your doctor, based on your own health and history.

If you take a different type of antidepressant, look it up on bumps and ask your doctor.

If you’re planning a pregnancy

If you’re trying to conceive, or thinking about it, talk to your GP before you start trying. Bumps says this is the best time to review your medicines, and your GP may refer you to specialist services. Don’t make changes before that conversation.

Specialist perinatal mental health support

Perinatal mental health services give specialist support during pregnancy and after birth. The NHS says you should be referred to one if you have a long-term mental health condition such as bipolar disorder, schizophrenia, OCD or an eating disorder. You should also be offered regular appointments with a midwife experienced in caring for people with conditions like yours. If you think this applies to you, ask your GP or midwife about a referral.

Whatever your situation, if your mood or anxiety changes at any point, tell your midwife or GP. See anxiety, low mood and loneliness in pregnancy.

Breastfeeding

The NHS says sertraline and citalopram are often fine to use while breastfeeding. Small amounts get into breast milk, so check with your doctor or pharmacist first. With fluoxetine, your doctor may suggest switching to another antidepressant, such as sertraline. In general, you’ll be advised to carry on if the benefit to you is greater than any possible risk to your baby. It can help to talk this through before your baby arrives.

If you need help now

If you feel you can’t keep yourself safe, call 999 or go to A&E. You can also call NHS 111 and choose the mental health option, or Samaritans on 116 123.

Questions people ask

Can I stay on sertraline while pregnant?

The NHS says sertraline can be used in pregnancy if needed. Your doctor will talk through the risks and benefits with you and prescribe the lowest dose that works.

Should I come off antidepressants when pregnant?

Not on your own. For some people continuing is right, for others a change is. It’s a decision to make with your doctor.

I stopped my antidepressants when I found out. What now?

Speak to your GP or mental health team soon and tell them how you’re feeling. They can help you decide what to do next. If you feel unwell or unsafe, use the urgent help above.

Will my baby have withdrawal symptoms?

Some babies have short-term symptoms after birth. If you’re taking an SSRI later in pregnancy, you’ll usually be advised to give birth in hospital, where your baby can be observed.