Psychiatric Medication During Pregnancy & Breastfeeding

Medically reviewed by Shahrzad Shadmani, PMHNP-BC, FNP-C

If you take medication for your mental health and you are pregnant, planning a pregnancy or breastfeeding, you deserve a careful, individual conversation — not a blanket instruction to stop, and not an assumption that nothing needs to change.

The question always has two sides

Every medication decision in pregnancy weighs the possible risks of the medication against the risks of the illness it treats. Both are real. Untreated depression, anxiety and bipolar disorder carry well-documented risks for the parent and the pregnancy, including relapse, preterm birth, pre-eclampsia, substance use and suicide. Leaving an illness untreated is also a decision with consequences.

What current guidance says

Current obstetric guidance recognizes SSRIs as a first-line treatment for depression and anxiety during pregnancy and after birth, and they are among the most extensively studied medications in pregnancy. The same guidance advises against stopping an effective medication on the basis of pregnancy alone, and often favors continuing a medication that has already worked for you over switching to something new.

A small number of psychiatric medications, such as valproate, carry well-established risks in pregnancy and are generally avoided when there are alternatives. Others, including lithium, can be used in pregnancy with closer monitoring. The details depend on the specific medication, the dose, the stage of pregnancy and your history — which is why the conversation has to be individual.

Planning ahead is best

The ideal time to review medication is before conception. It allows changes to be made gradually and deliberately, and means you start pregnancy with a plan rather than making decisions under pressure. If you are already pregnant, the next best time is now.

Breastfeeding

Many psychiatric medications are compatible with breastfeeding. The amount that passes into breast milk varies between medications, and the decision also takes into account your baby’s age and health. We coordinate with your baby’s pediatrician where that is helpful.

If you want to read further, LactMed, from the U.S. National Library of Medicine, is a reliable reference on medications and breastfeeding. It is a starting point for a conversation with your clinician, not a substitute for one.

Treatment after birth

Postpartum depression can be treated with the same approaches used at other times, and there are also newer medications developed specifically for postpartum depression. We can talk through whether any of them are appropriate for you. See postpartum mental health.

How we make these decisions with you

• We review your full history, including what has and has not worked before.
• We explain the evidence plainly, including where it is uncertain.
• We aim for the lowest effective dose and keep monitoring as your pregnancy progresses.
• We coordinate with your OB, midwife and pediatrician, with your permission.
• The final decision is yours, and we document the reasoning together.

Care is available by secure telehealth across California, Oregon, Washington and Colorado, and in person at our Mission Viejo office.

Frequently asked questions

I just found out I am pregnant. Should I stop my antidepressant?

Do not stop it on your own. Contact your prescriber as soon as you can. For many people, continuing is the safer choice, but it depends on the medication and your history.

Can I breastfeed while taking medication?

Often, yes. It depends on the specific medication and your baby. We will look at it with you.

Will you work with my OB?

Yes, with your permission. Joined-up care is safer care.

Related: Mental Health During Pregnancy · Postpartum Mental Health · Medication Management · Women’s Health & Hormonal Psychiatry