Healthcare professionals should follow the guidelines that NICE has produced on depression (see other NICE guidance for more information) but should adapt them as explained below. This is because some of the choices about treatment may be different for women during pregnancy and the first year after giving birth.
Some treatments or care described here may not be suitable for you. If you think that your treatment does not match this advice, talk to your care team and/or healthcare professional.
The treatment you are offered will depend on how severe your condition is and whether you've had the condition before.
If you have mild to moderate depression when you are pregnant or in the first year after you've had your baby, you may be offered:
self‑help (6 to 8 sessions with a practitioner over 9 to 12 weeks), or
medication if you have mild depression but have had severe depression in the past.
If you have moderate to severe depression, you may be offered:
psychological therapy such as cognitive behavioural therapy ('CBT' for short), or
medication if you decide to take this after thinking about the risks, or
psychological therapy with medication if you understand the risks of medication and psychological therapy alone hasn't worked.
The advice will depend on how severe your condition is.
If you have mild to moderate depression, your doctor should talk with you about stopping the medication gradually and starting a programme of self‑help (6 to 8 sessions with a practitioner over 9 to 12 weeks).
If you have moderate depression and would like to stop your medication, your doctor should talk with you about:
changing to a psychological therapy (such as CBT) and stopping medication, or
changing to a medication with a lower risk for you and your baby.
They should take into account the stage of your pregnancy, whether you might have a relapse (become unwell again) without your medication and how well medication has worked for you in the past.
If you have severe depression, your doctor should take into account how well your treatment is working, the risk to you and your baby if you carry on taking medication, the risk of your condition getting worse without medication and the stage of your pregnancy. They should talk with you about the following options:
carrying on with the medication
changing to a medication with a lower risk for you and your baby if this is likely to work
having psychological therapy (for example, CBT) as well as medication.
If you understand the risks to you and your baby and still decide you would like to stop medication, your doctor should discuss changing to psychological therapy (CBT).