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Depression - antenatal and postnatal - Pip - 08-21-2026 https://cks.nice.org.uk/topics/depression-antenatal-postnatal/ Depression - antenatal and postnatal Last revised in June 2026 Depression - antenatal and postnatal: Summary Depression refers to a spectrum of mental health problems characterized by the absence of positive affect (that is, a loss of interest and enjoyment in ordinary things and experiences), low mood, and additional emotional, cognitive, physical, and behavioural symptoms. Depression during pregnancy can be pre-existing or may develop during pregnancy. Postnatal depression is defined as developing up to one year after birth. Common misconceptions about postnatal depression are that symptoms and effects are less severe than depression experienced at other times, that it will go away by itself, and that it is entirely due to hormonal changes. The possibility of depression should be assessed at a pregnant woman's first contact with primary care, at her booking visit, and postnatally. The usual diagnostic criteria for depression should be followed for depression in the antenatal and postnatal periods. Decisions about treatment should be made on an individual basis, taking into account the risks and benefits of the options available to the woman. The woman (and her family, where appropriate) should be involved in all decisions about treatment. Treatment options depend on the severity of depression and include no intervention ('watchful waiting'), psychological treatment, antidepressant treatment, or a combination of psychological and antidepressant treatment. Women requiring psychological treatment should normally be assessed within 2 weeks of referral and seen promptly for treatment (ideally, within 1 month of initial assessment). Antidepressants can be used in pregnancy if clinically indicated. If a woman being treated for depression becomes pregnant, the risks of maternal relapse should be considered before stopping or switching antidepressant treatment. In a woman with a new episode of antenatal depression, the risks and benefits of drug treatment should be weighed up, including the risks to the woman, baby, and her wider family posed by untreated depression and any identified fetal risks of using the medicine at the relevant stage of pregnancy. Specialist advice on medication use in pregnancy may be sought from the UK Teratology Information Service (UKTIS), or, if locally available, a specialist perinatal mental health team.  Antidepressants can be used in the postnatal period if clinically indicated. For women on established treatment, the risks of maternal relapse should be considered before switching antidepressants. If treatment is newly initiated and the woman is breastfeeding, specialist advice regarding the most appropriate medication can be sought from the UK Drugs in Lactation Advisory Service (UKDILAS), from a specialist perinatal mental health team where available, or from secondary psychiatric care.  Antidepressant treatment should be discussed with a paediatrician if the baby is premature, has health problems, or has liver or kidney impairment. Sertraline and paroxetine are generally the selective serotonin reuptake inhibitors (SSRIs) of choice for treatment that is initiated during breastfeeding. Imipramine and nortriptyline are the preferred tricyclic antidepressants in breastfeeding. Doxepin should be avoided.