Last updated March 2012. Planned review date: March 2014
Where to get help
You should seek help if you think you are depressed, have any of the conditions in this section or just feel like you can't cope in pregnancy.
If you are extremely stressed, anxious or depressed during your pregnancy, your baby may be at an increased risk of being born prematurely and being smaller for gestational age.
The important thing to remember is that all these issues can be treated, so talk to your midwife or doctor in the first instance if you’re worried. Your hospital may have a dedicated midwife or team who specialise in mental health conditions that will be able to offer you advice and support.
Treatment is usually counselling or other psychological methods but some people also need medication. Your doctor will make sure you have the medicine that’s safest for you and your baby.
Be honest at your booking appointment
When you first see any healthcare professional about having a baby (at your 'booking appointment') or after your baby is born, they should ask you about your mental health. This conversation should include whether you have, or have ever had, a severe mental illness, including schizophrenia, bipolar disorder or severe depression, or if you have had psychosis after giving birth. They should also ask about any treatment you have had from a psychiatrist or specialist mental health team, including treatment in hospital, and about whether anyone in your family has had mental health problems during pregnancy or after giving birth.
You should also be asked the following questions at the same time, and also usually four to six weeks and three to four months after you have given birth. These are standard questions that everyone is asked to help pick up signs of depression.
- During the past month, have you often been bothered by feeling down, depressed or hopeless?
- During the past month, have you often been bothered by having little interest or pleasure in doing things?
Depending on your answers you may also be asked: ‘Is this something you feel you need or want help with?’
If your answers suggest you may have depression, you may be asked to fill in a questionnaire, which will help your midwife, health visitor or doctor understand more about how you are feeling.
If you, or a healthcare professional, think you may have a mental health problem, you should usually be offered a further assessment with your GP. If the problem is severe (for example, schizophrenia or bipolar disorder) you should be referred to a specialist mental health service, after discussion between you and your GP.
If you need extra support
If you’re already under the care of a community mental health team (CMHT), you should tell your care co-ordinator that you’re pregnant. They will be able to tell you about the treatment and support that are available for pregnant women and new mums in your area. If you are not under the care of a CMHT, but have been in the past, you should talk to your GP. You may need the support of the CMHT during pregnancy and for a few months after your baby is born. The support you need while you’re pregnant depends on the type of illness you have had.
Taking antidepressants in pregnancy
If you were taking antidepressants for mild depression before you became pregnant, you may be advised to stop taking them during pregnancy. Always discuss this with your doctor, as women with more severe forms of depression may be advised to stay on their antidepressants or switch to a different kind that is considered safer during pregnancy.
There are a number of studies currently investigating how antidepressants affect pregnancy and unborn babies. Tricyclic antidepressants, such as amitriptyline, were thought to have fewer risks during pregnancy than other antidepressants. Recently, newer types of antidepressants, called SSRIs, have been more commonly prescribed as they have fewer side effects for pregnant women. Talk to your doctor about the up-to-date evidence on the safety of antidepressants in pregnancy. Together you can come to a decision about whether you should be taking this type of medication based on the risks and benefits for you and your baby.
More sources of help
The following organisations all deal with mental health for pregnant women and new mothers.
Association for Postnatal Illness
Postpartum Support International
Action on Postpartum Psychosis (www.app-network.org).
For more expert information call the Tommy’s PregnancyLine on 0800 0147 800 or email firstname.lastname@example.org
Mulder EJ, Robles de Medina PG, Huizink AC (2002) Prenatal maternal stress: effects on pregnancy and the (unborn) child, Early Human Development, Dec;70(1-2):3-14
NICE (2007) Antenatal and postnatal mental health, The NICE guideline on clinical management and service guidance, National Institute for Health and Clinical Excellence
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