Treatment options for mental illness include medication and talking therapy.
If you’re planning a pregnancy or you’re pregnant, it’s natural to worry about how your medication might affect your baby, but it’s important that you don’t stop taking any medication without speaking to your doctor first, because this could make your symptoms come back or get worse.
Because some women get pregnant very quickly (1 in 3 women who are trying for a baby will conceive within a month), it’s a good idea to keep using contraception until you’ve spoken to your doctor about your treatment.
‘I saw the doctors. They were good. They looked at it quite realistically and it wasn’t wrapped up in cotton wool. It wasn’t fluffy. It was straightforward: "These are your options, we can change your medicine but on the other hand it might not be a good idea." They told me how it might affect the baby in the first trimester. It was pretty matter of fact, and it was really good to have that advice. The more advice I get from professionals the better.’
Woman, pregnant with bipolar disorder
Keeping yourself well is the first step in keeping your baby well.
Women often have to take medication for physical or mental illnesses in pregnancy. For many women who have a severe mental illness, taking medication is the only way to make sure they stay well.
Many mental illness medications are commonly used in pregnancy but we know more about some medication than others.
Ask your GP to refer you to a psychiatrist or mental health professional who specialises in pregnancy (called a perinatal mental health professional). They can talk to you about the risks and benefits of taking medication during pregnancy.
It’s your decision whether to take medication in pregnancy. If you decide that the best option is to stop, your doctor will talk with you about any risks of becoming unwell again and how untreated illness may affect you and your baby.
They will explain how they can monitor your mental wellbeing so that any signs of your mental illness coming back are picked up quickly and treated.
Many women worry about the chances of medication affecting their baby, but it’s also important to think about how stopping medication could affect your mental health. If your mental health worsens you may be unable to look after your baby so keeping yourself well is important for keeping your baby well.
Don’t stop taking medicine for a mental illness before talking to a doctor. This can lead to withdrawal symptoms, particularly if you stop suddenly, or it could make your mental illness symptoms come back or get worse.
If you’re already pregnant, keep taking your medication and speak to your GP, psychiatrist or perinatal mental health professional straight away.
Your psychiatrist or perinatal mental health team will talk to you about the medicines you’re taking, including any over the counter medicines. They will explain your options to help you decide what’s best for you.
‘It was absolutely invaluable to see the perinatal psychiatrist because.to him it was so fundamental to talk about things like sleep, breast-feeding, hospitalisation, medication, treatment, all of those kinds of things. He's got the experience that I know other doctors, even all psychiatrists, don’t have. It was very helpful, talking about the percentage risks and the risks at different periods. You just couldn’t get that information from anyone else’.
Woman, planning a pregnancy with a serious mental illness
Your options may include:
- starting medication if you’re not already taking any
- staying on your current medication throughout conception, pregnancy, and birth
- switching to another medicine that’s less likely to cause side effects for you and your baby
- gradually stopping your medication
- using other treatments instead of, or together with, medication, such as talking therapies.
They will also talk to you about your treatment options after your baby is born.
- how unwell you have been in the past
- what usually happens when you are ill – for example, does it mean you are less likely to look after yourself or need to go to hospital?
- how quickly you have become unwell if you have stopped medication before
- what medications have helped you the most
- if any medications have caused side effects
- whether you have any other health problems that may affect your pregnancy.
If you decide that the best option is to continue taking medication but you’re worried about how it may affect your baby, you may be able to take a lower dose or reduce the number of medicines you’re taking.
Your doctor may suggest psychological (talking) therapy, either alone or together with medication. Talking therapies can be one-to-one, in a group, or with your family or partner. You can also have mother-infant therapy.
Your psychiatrist or perinatal mental health professional can tell you which talking therapy is available. Depending on your mental illness symptoms, you may be able to access therapy through your local psychological therapy service, the perinatal mental health team or general adult mental health services.
Sodium valproate is an anticonvulsant medicine sometimes used to treat bipolar disorder.
You shouldn’t take valproate if you’re planning a pregnancy or if you are pregnant. This is because it causes high numbers of birth defects including neural tube defects, such as spina bifida, and problems with the baby’s learning and development.
If you already take valproate, you may be enrolled in the Pregnancy Prevention Programme (PPP). The programme helps you avoid an unplanned pregnancy by giving you advice on the most effective contraception. This doesn’t mean you can’t get pregnant in the future.
If you’re already pregnant and you’re taking valproate, tell your doctor straight away. They will talk to you about your other treatment options.
All medications for mental illness pass into breastmilk to some extent, but for many of them it is in small amounts. Talk to your psychiatrist or perinatal mental health professional about this. They can tell you the risks and benefits of taking medication when you’re breastfeeding. These need to be weighed up in the same way as for medication in pregnancy, thinking about your individual history of mental illness and treatment.
More information and support
Information on the use of specific medicines in pregnancy
Support and advice for anyone experiencing mental illness, including information on talking therapies.