Treatments for severe mental illness before, during and after pregnancy

Treatment options for mental illness include medication and talking therapy

If you’re pregnant or planning a pregnancy, it’s natural to worry about how your medication might affect your baby.

It’s important that you don’t stop taking any medication without speaking to your doctor first. This could make your symptoms come back or get worse, which may not be safe for you or your baby.

It’s a good idea to keep using contraception until you’ve spoken to your doctor about your treatment as you could become pregnant quickly.

On this page

Can I take medication during pregnancy? 

What if I want to stop taking my medication? 

How can talking to health professionals help?

Talking therapy

Valproate in pregnancy

Can I take medication when I am breastfeeding?

More information and support

 

Can I take medication during pregnancy?

Keeping yourself well is the first step in keeping your baby well.

For many people who have a severe mental illness, taking medication is the only way to make sure they stay well. However, your doctor may recommend switching to a different medication, or changing your dose.

Many mental illness medications are commonly used in pregnancy. 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. This is called a perinatal mental health professional. They can talk to you about the risks and benefits of taking medication during pregnancy.

If you give up smoking before or during pregnancy, you may need to take a lower dose of your medication. This is because smoking can make your body process some medicines more quickly. 

Read more about smoking and mental health medication here.

You can find out how your specific medication may affect conception and pregnancy on the BUMPS medicines in pregnancy website. We have more information on thinking about risk and making decisions about your pregnancy here.

What if I want to stop taking my medication?

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. They’ll explain how untreated illness may affect you and your baby.

They will also offer to monitor your mental wellbeing more closely during your pregnancy. That way, any signs of your mental illness coming back are picked up quickly and treated.

You may worry about the chances of medication affecting your baby. However, 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 yourself and your baby. Keeping yourself well is important for keeping your baby well.

Don’t stop taking medicine for a mental illness before talking to a doctor. It could make your symptoms come back or get worse. A doctor can help you stop taking your medication in a safer way, and reduce the risk of withdrawal symptoms.

If you’re already pregnant, keep taking your medication. Speak to your GP, psychiatrist or perinatal mental health professional straight away.

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.

Wendy

How can talking to health professionals help?

Your psychiatrist or perinatal mental health team will talk to you about the medicines you’re taking. This includes any over-the-counter medicines. They will explain your options to help you decide what’s best for you.

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.

To help you decide what is best for you and your baby, you may want to think about:

  • 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, you may be able to take a lower dose or reduce the number of medicines you’re taking.  

Your GP, psychiatrist or perinatal mental health professional will offer you regular monitoring. They’ll check to see how you respond to any changes in your medication.  

Read more about who will be involved in your care when you are pregnant with a severe mental illness.

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.

Anna

Talking therapy

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 may also be offered parent-infant therapy.

Your GP, midwife, psychiatrist or perinatal mental health professional can tell you which talking therapy is available.

You may be able to access therapy through your local psychological therapy service. It may also be offered by the perinatal mental health team or general adult mental health services.

Valproate in pregnancy

Sodium valproate (also known as Epilim) and valproic acid (also known as Depakote or Convulex), are medicines sometimes used to treat epilepsy or 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. These include 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.

Don’t stop taking valproate without talking to your doctor first. Stopping suddenly may not be safe for you or your baby.

Can I take medication when I am breastfeeding?

It depends which medication you’re taking. Many medicines pass into breastmilk, but often only in small amounts.

Talk to your psychiatrist or perinatal mental health professional. 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. Your doctor will discuss your individual history of mental illness and treatment.

There are a few medicines that are generally not recommended while breastfeeding. These include valproate, lithium, clozapine and carbamazepine. 
 

More information and support

BUMPS 
Information on the use of specific medicines in pregnancy.

Mind 
Support and advice for anyone experiencing mental illness, including information on talking therapies.

Thinking of trying for a baby? Use our Planning for Pregnancy tool to get personalised information to help you have the healthiest possible pregnancy.

 

NHS. Medicines in pregnancy. Available at: https://www.nhs.uk/pregnancy/keeping-well/medicines/ Page last reviewed: 5 September 2022, Next review due: 5 September 2025

National Institute for Health and Care Excellence. 2023. Pre-conception – advice and management. Available at: https://cks.nice.org.uk/topics/pre-conception-advice-management/ 

Campion J et al. 2017. Pharmacy guidance on smoking and mental disorder. Royal College of Psychiatrists, National Pharmacy Association and Royal Pharmaceutical Society. Available at: https://www.drugsandalcohol.ie/27195/ 

National Institute for Health and Care Excellence. 2020. Antenatal and postnatal mental health: clinical management and service guidance. Available at: https://www.nice.org.uk/guidance/cg192 

Royal College of Psychiatrists. What are Perinatal Mental Health Services? Available at: https://www.rcpsych.ac.uk/mental-health/treatments-and-wellbeing/what-are-perinatal-mental-health-services Page last reviewed: November 2018, Next review due: November 2021 

UK Teratology Information Service. 2020. Sodium valproate. Available at: https://www.medicinesinpregnancy.org/Medicine--pregnancy/Valproic-acid/ 

NHS. Breastfeeding and medicines. Available at: https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/breastfeeding-and-lifestyle/medicines/ Page last reviewed: 7 September 2022, Next review due: 7 September 2025

Review dates
Reviewed: 17 July 2024
Next review: 17 July 2027