Antidepressants 'are the only option for some women' Many women feel guilty about taking medication when they are trying to conceive or find out that they are pregnant and it is no different for those with depression. However, both coming off antidepressants suddenly or leaving the illness untreated, holds risks for the mother and the foetus. So what should a woman do? Depression is a serious illness, and can affect women at any point in their lives with devastating impact. Contrary to popular belief the prevalence of mental disorders during pregnancy is no greater than other times in a woman's life, neither is pregnancy protective against mental illness, as some believe. Depression can be treated with talking therapies and medication, or a combination of the two. As clinicians, we would always prefer not to give women of child-bearing age medication but the reality is that for women with severe depression, antidepressants are sometimes the only option. Left untreated, depression during pregnancy can impact on everyday functioning and self-care, for example poor nutrition, in addition, research has shown there is an increased risk of suicide. We also know that depression during pregnancy is linked to post-natal depression. All of these, directly and indirectly impact on the health and well-being of the child. The risks of taking most antidepressants are very small and new research is coming out all the time. Drugs associated with significant problems are not antidepressants but medication for rarer mental health disorders some of which are known to cause side effects during pregnancy, for example Sodium Valporene which clinicians would only prescribe as a last resort. We need to give women the facts, especially if they are considering having children. Evidence for giving women any type of medication during pregnancy is limited, and more research is needed. But, for now we go on what we know and for each woman, we need to carefully weigh up the risks of taking medication with the risks of the illness, all the time respecting her individual wishes. We would all like to see into the future but in practice 50% of pregnancies are unplanned, so it is sensible for a woman of child-bearing age who is on antidepressants to discuss the risks, and also benefits of treatment, with their doctor. Professor Louise Howard is head of women's mental health at the Institute of Psychiatry, King's College London.