Minor changes since publication
February 2020: We amended recommendation 126.96.36.199 in line with the MHRA guidance on valproate use by women and girls. The MHRA states that valproate must not be used in women and girls of childbearing potential (including young girls who are likely to need treatment into their childbearing years), unless other options are unsuitable and the pregnancy prevention programme is in place. We did this by moving cautions and links to the MHRA's latest advice on valproate into the recommendations.
Medicines containing valproate taken in pregnancy can cause malformations in 11% of babies and developmental disorders in 30–40% of children after birth. Valproate treatment must not be used in girls and women including in young girls below the age of puberty, unless alternative treatments are not suitable and unless the terms of the pregnancy prevention programme are met. This programme includes: assessment of patients for the potential of becoming pregnant; pregnancy tests; counselling patients about the risks of valproate treatment; explaining the need for effective contraception throughout treatment; regular (at least annual) reviews of treatment by a specialist, and completion of a risk acknowledgement form. In pregnancy, valproate is contraindicated and an alternative treatment should be decided on, with appropriate specialist consultation. See the MHRA toolkit to ensure female patients are better informed about the risks of taking valproate during pregnancy.
September 2019: Recommendation 1.9.21 on stopping antidepressants has been replaced and a new recommendation 1.9.22 added, and subsequent recommendations renumbered. This is to bring the advice in this section in line with current practice.
April 2016: Recommendation 188.8.131.52 has been deleted and replaced with a link to the NICE interventional procedures guidance on repetitive transcranial magnetic stimulation for depression.