Mental health treatment before, during and after pregnancy

Information for you about different types of treatment for mental health illness before, during and after pregnancy if you have a serious mental illness and are planning to become pregnant.

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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?

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

Can I take medication during pregnancy?

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 or had 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.

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

You can find out how your specific medication may affect conception and pregnancy on the BUMPS website.

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 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.

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.

How can talking to health professionals help?

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.

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 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 GP, psychiatrist or perinatal mental health professional will offer you regular checks to see how you respond to any changes in your medication.

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 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.

Valproate in pregnancy

Sodium valproateis 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.

Can I take medication when I am breastfeeding?

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.

There are a few medicines that are generally not recommended in breastfeeding. These include 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.

Sources

[1] Campion J, Hewitt J, Shiers D, Taylor D (2017) Pharmacy guidance on smoking and mental disorder – 2017 update. Royal College of Psychiatrists, National Pharmacy Association and Royal Pharmaceutical Society.

[2] Medicines and Healthcare products Regulatory Agency (2018, updated 2019) Guidance: Valproate use by women and girls www.gov.uk/guidance/valproate-use-by-women-and-girls

[3] UK Teratology Information Service (2015) Use of carbamazepine in pregnancy www.medicinesinpregnancy.org/bumps/monographs/USE-OF-CARBAMAZEPINE-IN-PREGNANCY/

[4] Medicines and Healthcare products Regulatory Agency (2018, updated 2019) Guidance: Valproate use by women and girls www.gov.uk/guidance/valproate-use-by-women-and-girls

[5] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[6] National Institute for Health and Care Excellence (2014, updated 2018) Antenatal and postnatal mental health: clinical management and service guidance. Clinical guideline [CG192]

[7] Pan-London Perinatal Mental Health Networks (2019) Pre-conception advice: Best Practice Toolkit for Perinatal Mental Health Services. www.healthylondon.org/wp-content/uploads/2019/05/Pre-conception-advice-Best-Practice-Toolkit-for-Perinatal-Mental-Health-Services.pdf

[8] McAllister-Williams RH et al. (2017) British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 31(5): 519-552. 

[9] Pan-London Perinatal Mental Health Networks (2019) Pre-conception advice: Best Practice Toolkit for Perinatal Mental Health Services. www.healthylondon.org/wp-content/uploads/2019/05/Pre-conception-advice-Best-Practice-Toolkit-for-Perinatal-Mental-Health-Services.pdf

[10] McAllister-Williams RH et al. (2017) British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 31(5): 519-552. 

[11] McAllister-Williams RH et al. (2017) British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol. 31(5): 519-552. 

[12] Pan-London Perinatal Mental Health Networks (2019) Pre-conception advice: Best Practice Toolkit for Perinatal Mental Health Services. www.healthylondon.org/wp-content/uploads/2019/05/Pre-conception-advice-Best-Practice-Toolkit-for-Perinatal-Mental-Health-Services.pdf

[13] Royal College of Psychiatrists (2015) Perinatal mental health services Recommendations for the provision of services for childbearing women CR197 https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr197.pdf?sfvrsn=57766e79_2

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