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Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Antenatal depression and anxiety

Psychiatry · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

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Antenatal mental-health crisis

Suicidal intent, severe self-neglect, psychosis, mania, catatonia, dangerous substance use, inability to eat or drink, or risk from domestic abuse requires urgent assessment; obstetric symptoms such as heavy bleeding, collapse, severe headache or reduced fetal movement need the appropriate maternity emergency pathway in parallel.

Action: Establish immediate safety, gestation, location and support; ask directly about suicide, harm, psychosis, abuse and fetal concerns; arrange same-day mental-health or emergency assessment, contact maternity triage for obstetric danger, and do not leave the person alone when imminent harm is plausible.

Synopsis

Identify depression and the full range of anxiety disorders during pregnancy, formulate obstetric and psychosocial context, assess safety, and sequence timely psychological and pharmacological care through shared decision-making.

  • Depression and anxiety disorders are under-recognised in pregnancy; ask within a general, non-judgemental conversation rather than waiting for visible distress.
  • Explore low mood and lost interest, GAD-2 symptoms, panic, obsessions, compulsions, trauma, social fear, tokophobia and illness anxiety because 'worry' is not one diagnosis.
  • A positive identification question or questionnaire is an invitation to full assessment, not a diagnosis or a suicide-risk score.
  • Assess suicide, self-neglect, substance use, domestic abuse, obstetric health, bipolarity, psychosis, eating, sleep, support and ability to engage with maternity care.
  • For persistent subthreshold symptoms or mild-to-moderate depression, NICE says to consider facilitated self-help.
  • For moderate or severe depression, consider high-intensity psychological therapy, an antidepressant after informed preference-based discussion, or combination treatment after limited response to either alone.
  • For an anxiety disorder, offer the disorder-specific low- or high-intensity psychological intervention; PTSD and social anxiety begin with high-intensity treatment.
  • If a referred person has a known or suspected perinatal mental-health problem, NICE expects treatment assessment within two weeks and psychological intervention within one month of initial assessment.
  • Do not stop an effective antidepressant abruptly after pregnancy is discovered; compare relapse, withdrawal, gestational stage and medicine-specific risks.
  • Plan postnatal monitoring before birth because sleep loss and service transitions can reveal or amplify severe illness.

    • Key red flags

    A suicide plan, recent high-lethality self-harm, psychotic depression or stated inability to remain safe needs immediate senior mental-health assessment.

    Decreased need for sleep with elation, grandiosity, disinhibition or psychosis suggests mania rather than uncomplicated anxiety and makes antidepressant escalation unsafe.

    Food or fluid refusal, marked weight loss, dehydration, severe insomnia or inability to attend essential antenatal care indicates serious functional compromise.

    Fear of a partner, unexplained injuries, surveillance of communication, reproductive coercion or being prevented from speaking alone requires private domestic-abuse and safeguarding enquiry.

    Vaginal bleeding, severe abdominal pain, collapse, seizures, severe headache, visual symptoms or reduced fetal movements must not be attributed to anxiety without maternity assessment.

    Investigation priorities

    01
    Clinical diagnostic interviewFirst step

    Characterise symptom clusters, duration, impairment, previous episodes, mania, psychosis, trauma, substance use and treatment response.

    Management branches

    RecognitionMove from screen to formulation

    Identification questions, a score, observed distress or clinical concern suggests depression or anxiety during pregnancy.

    1. Clarify the complete syndrome, duration, function, gestation and the person's explanation of what is happening.
    2. Assess suicide, self-neglect, abuse, substances, mania, psychosis, physical illness and obstetric danger directly.
    3. Agree diagnosis or working formulation, urgency, monitoring measures and which maternity, primary-care or mental-health service owns each action.

    Key medicines

    Sertraline example regimenFor adult major depression, the SmPC starting dose is 50 mg orally once daily. If response is insufficient, increase in 50 mg steps no more often than weekly to a maximum of 200 mg daily; maintain the lowest effective dose and taper rather than stop abruptly.Check bipolar features, suicidality, hyponatraemia risk, bleeding medicines and serotonergic interactions. Discuss uncertain reproductive evidence, possible neonatal adaptation symptoms and PPHN signal with late exposure, and the small increased postpartum-haemorrhage risk with SSRI or SNRI use in the month before delivery.
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    Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
    Sources

    Sources and review status

    National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

    • NICE CG192 clinical recommendationsIdentification, assessment timeframes and treatment sequencing for perinatal depression and anxiety.
    • NICE NG222 adult depressionDepression assessment, psychological approaches and general treatment principles referenced by CG192.
    • MHRA antidepressant haemorrhage adviceSmall late-pregnancy postpartum-haemorrhage signal and individual balancing.
    • Sertraline 50 mg SmPCLicensed adult doses, titration, discontinuation and pregnancy or neonatal cautions.

    Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

    Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom