More information about medication

Many types of medication for mental health problems may affect your baby if you take them when you are pregnant or when you are breastfeeding. But there is also a risk for your baby if you become seriously unwell because you are not taking medication. Whether you take medication will depend on the particular type of medication and how likely you are to become unwell without it.

Your doctor should give you information about the risks of starting, stopping, continuing or changing medication and should discuss this with you.

Your doctor should discuss breastfeeding with you and tell you about treatments that you could take if you decide to breastfeed.

Anticonvulsants (valproate, carbamazepine, lamotrigine)

There are serious risks to your baby if you take valproate (spina bifida and learning difficulties) or carbamazepine (spina bifida, heart problems and cleft palate) when you are pregnant.

  • Valproate is not recommended for women with a mental health problem until they are past their childbearing years.

  • Carbamazepine is not recommended for women who are planning to have a baby, pregnant or breastfeeding.

If you are already taking valproate or carbamazepine and you are planning to have a baby or become pregnant, you should be advised to stop the medication.

If you decide to take lamotrigine when you are pregnant, your doctor should carry out regular checks of the levels in your blood because these can vary quite a lot at this time.

Antidepressants

Antidepressants can be used to treat anxiety disorders as well as depression. Your doctor should discuss the risks from different antidepressants with you, including:

  • what is known about their safety during pregnancy (for example, there is a risk your baby may have heart problems or be born with high blood pressure)

  • the risk your baby will have some 'withdrawal' symptoms caused by antidepressants taken during pregnancy, particularly venlafaxine and paroxetine.

Antipsychotics

If you're taking an antipsychotic and are likely to become unwell without medication, you should be advised to carry on taking it.

Antipsychotics can make you put on weight and are linked to diabetes. Your doctor should advise you on healthy eating and staying a healthy weight. If you take an antipsychotic for a mental health problem, you should have your weight checked and be tested for diabetes regularly.

You shouldn't usually be given an antipsychotic by injection (known as a depot antipsychotic) unless you've got on well with this in the past and have trouble taking tablets regularly.

If you are taking clozapine you should be advised not to breastfeed because clozapine can cause problems for your baby (fits and blood problems).

Benzodiazepines

You should not usually be offered this medication when you are pregnant, because of risks to your baby, except for a short time if you have severe anxiety or are extremely agitated.

If you are taking a benzodiazepine and you're pregnant or thinking about breastfeeding, you should think about gradually stopping the medication.

Lithium

You should not usually be offered lithium if you are pregnant because there is a risk of heart problems for your baby. But your doctor may offer it to you if you've taken an antipsychotic and it hasn't helped. Your doctor should make sure you know the risks to yourself and your baby. They should advise you not to breastfeed while taking lithium because high levels of lithium in breast milk may cause problems for your baby.

  • If you become pregnant while taking lithium, you should usually be advised to stop taking it gradually over 4 weeks. But even if you do this, there is still a risk to your baby.

  • If you are unwell, or likely to become ill again, your doctor may advise you to continue on lithium, or gradually change to an antipsychotic. Another option is to stop taking lithium for a while and start again later in pregnancy.

  • If you continue to take lithium, you should take as low a dose as possible, you should have regular blood tests and drink plenty of water.

  • When you go into labour, you should stop taking lithium.

  • You should have your baby in hospital so that you can be monitored during labour.

Off-label medicines

In the UK, medicines are licensed to show that they work well enough and are safe enough to be used for specific conditions and groups of people. Some medicines can also be helpful for conditions or people they are not specifically for. This is called 'off‑label' use. Off‑label use might also mean the medicine is taken at a different dose or in a different way to the licence, such as using a cream or taking a tablet.

There aren't any medicines licensed in the UK for treating mental health problems in women when they are pregnant or breastfeeding. Any medication you take to treat a mental health problem when you are pregnant or breastfeeding would be described as 'off‑label'. If you are offered any 'off‑label' medicines, then your doctor should tell you this and discuss this with you. There is more information about licensing medicines on NHS Choices.

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