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Antidepressant medication during pregnancy and breastfeeding

Information for pregnant women

During your pregnancy it is really important for you to have a stable mood and be comfortable on your antidepressant medication as part of providing a safe environment for your baby.

Taking antidepressant medication during your pregnancy

Mood and anxiety disorders need to be treated appropriately during pregnancy. This could include the need for antidepressant medication which is safe, effective and not addictive. Among the antidepressant medications often prescribed to treat mood and anxiety disorders are Selective Serotonin Reuptake Inhibitors (SSRI) and Selective Noradrenaline Reuptake Inhibitors (SNRI).

Babies can be exposed to these medications because they cross the placenta. Exposure to antidepressant medication in late pregnancy can result in your baby having “discontinuation syndrome”.

Symptoms of discontinuation syndrome occur in approximately one in three babies who have been exposed to SSRI or SNRI medication. Symptoms are usually mild and disappear within a few days. However, moderate to severe symptoms have also been reported. These symptoms include respiratory problems, temperature changes, feeding difficulties, vomiting, tremors, jitteriness, prolonged or constant crying, muscle tone changes, irritability, seizures, settling difficulties, floppiness, rigidity, low blood sugars and jaundice. In a small proportion of babies, symptoms are severe enough to require admission to a neonatal unit for treatment.

Antenatal management

If you are taking SSRI or SNRI antidepressant medication antenatally, please ensure your hospital doctor, and/or midwife is notified. You may be offered an appointment to speak with the Mater Mother’s Hospital (MMH) Consultation Liaison Psychiatry (CLP) team to discuss the possible risks and benefits of your medication being continued in the third trimester. Any adjustments in dose should take place under the supervision of a doctor. We strongly recommend against reducing or ceasing your medication without consultation.

The National Prescribing Service Medicines Information line 1300 888 763 can also help answer questions you might have about the safety of your antidepressant medication during pregnancy. You may also be offered an appointment with a lactation consultant.

Postnatal management

Postnatally, ensure you continue to take your antidepressant medication as prescribed. If you need pain relief, your doctor will prescribe treatment that is compatible with your medication. Please ask for help from your midwife if you need support or assistance with breastfeeding or other baby cares. We also recommend you see the CLP team on the postnatal ward before discharge.

Care of your baby

We recommend that you and your baby should remain on the postnatal ward for three days, and you will be reviewed daily by a doctor. If you and your baby are discharged before day three you will be offered referral to MMH’s Home Care Program (HCP). Unless there are other medical concerns, your baby will be observed during normal mother/baby/midwife contact and will have regular monitoring of their temperature, heart rate and breathing. Extra monitoring may be required to ensure other signs of discontinuation syndrome are not missed. Please report any concerns you may have about your baby to your midwife.

The paediatrician will check your baby during their admission and will ensure a discharge plan is in place including referral to child health or an early appointment back to your general practitioner.

Follow up

Please make an appointment to see your GP within one week of discharge. We also advise you to make an appointment with your prescribing doctor once you are discharged from MMH for the purpose of reviewing your antidepressant medication dose.

Some useful contact phone numbers:

Child Health Line

07 3862 2333 or 1800 177 279

Beyondblue info line

1300 224 636

Australian Breastfeeding Association Helpline

07 3844 8977

Queensland Lactation Consultants

07 3396 9718

Medicines Line (Mon—Fri 9am–6 pm)

1300 888 763

Mental Health Services (Princess Alexandra Hospital)

1300 858 998

References

Royal Australian and New Zealand College of Psychiatrists. Practice Guidelines. GUIDANCE ON THE USE OF SSRIS AND VENLAFAXINE (SNRI) IN LATE PREGNANCY. December 2005. Cited on 29/9/2008 at: https://www.ranzcp.org/Publications/Guidelines-for-clinical-practice.aspx

Beyondblue. The National depression Initiative. Emotional Health During Pregnancy and Early Parenthood. 2008. www.beyondblue.org.au

Mater acknowledges consumer consultation in the development of this patient information.
Mater Doc Num: PI-CLN-430031
Last modified 09/8/2017.
Consumers were consulted in the development of this patient information.
Last consumer engagement date: 18/1/2014
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