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Fluoxetine in Pregnancy

(13 Posts)
GinaFB Wed 07-Jul-10 14:21:59

I am after some guidance please.

I have been taking a low dose of Fluoxetine for about 12 months now and I am pregnant again (due Feb). I was told when pregnant with a previous pregnancy (that did not get to term earlier in the year) that this was all ok and nothing to worry about and that I would not need to change this in anyway.

I have just seen my midwife who has said that I will probably need to change this to an alternative anti depressant and that the baby could suffer withdrawal symptoms once born, I would also be unable to breast feed with this AD. This is totally different to the advice last time.

Has anyone else been in the position of taking fluoxetine in pregnancy and if so what was the outcome or what advice where they given?

Thanks ladies x

japhrimel Wed 07-Jul-10 14:58:48

Of the SSRIs, Fluoxetine is often recommended because to date it has the most evidence of its safety as it has been around the longest.

However, the BNF advice on anti-depressants and pregnancy says:

"If SSRIs are used during the third trimester there is a risk of neonatal withdrawal symptoms, particularly with fluoxetine and paroxetine"

The BNF also notes that Fluoxetine is present in the breast milk of mothers taking it so should be avoided if possible.

One study I saw linked to on Motherisk (international experts on medications while pregnant or breastfeeding) said that 10% of the adult dose of Fluoxetine can be present in breastmilk.

The only SSRI listed in the BNF that specifically says it is present at such low amounts in breast milk to not worry about is Paroxetine.

As with many medications it's a case of weighing up the risks/benefits of any course (e.g. including the risk of unmanaged depression if you start playing around with meds!). Definitely talk to your GP.

GinaFB Wed 07-Jul-10 16:16:43

I have booked an appt with my GP however I am serious considering coming off the Fluoxetine completely to avoid problems like this. It is a very low dose however I a uncertain how this would affect me mentally. Would this cause any "withdrawal" problems?

japhrimel Wed 07-Jul-10 17:06:32

Yes, it could cause you withdrawal issues so I would talk to your GP before doing this. If you and your GP are happy to do it, it might be good to try coming off it for the rest of the 1st trimester at least. However, if you then have a relapse, it can take a few weeks for the meds to kick in again, so it is a risk.

TBH I would be careful right now. In the first trimester your hormones are all over the place, so depression and anxiety can be issues even if you were fine before getting pregnant.

Have a good chat with your GP. Another option would be for you to stick with the fluoxetine for now, but consider changing to paroxetine later in the pregnancy so you can then carry on taking it when breastfeeding with less worry.

danniied13 Wed 07-Jul-10 17:10:46

My midwife has advised me to go back on mine as I am that depressed at the moment. I am 31wks and was on Citalopram. I am just waiting to hear from the GP now.

glasgowlass Wed 07-Jul-10 17:16:47

I was on 20mg fluoxetine from 13 weeks pregnant, still on drug now though 40mg(DS is 20 months) My GP contacted a perinatal specialist before prescribing me them who told her that it was the drug with most research done in pregnancy and he deemed it safe to use. He did however mention possibility of withdrawal for DS but he was ok in the end.
Wasn't a problem re the risk to passing to DS through breastmilk for me as I couldnt BF due to a different medical condition.

Could you ask your GP to refer you to or to speak to a perinatologist on your behalf? Might help you put your mind at ease.

Best of luck.

NeedToSleepZZZ Wed 07-Jul-10 20:22:39

Thank you for asking this question GinaFB, I am taking 20mg fluoxetine atm and am 13 weeks and hadn't considered whether I could bf as my doctor was happy for me to continue taking it. Will ask at 16 weeks if I can try and come off it, I took paroxetine years ago and it seriously disagreed with me so won't be going down that route again.

Not sure what to do now...confused

LackaDAISYcal Wed 07-Jul-10 20:36:56

I was taking sertraline because I was BFing and got pregnant again. I was advised to come off the ADs for the first trimester, and then put onto fluoxetine for the duration of the pregnancy because as others have said, it is the drug with the most known effects in pregnancy.

DS did need a bit of help after he was born, and suffered some withdrawal, but this amounted to him being quite cold and needing a bit of incubation, but only for a few hours, and then he was very closely monitored for a few days before we were allowed home. His blood sugar levels were quite low and he was a bit shaky, but nothing more serious than that, and they couldn't even say whether it was down to the drug or not.

Anyhoo, I was under the care of the perinatal MH team, and they had me prescribed some sertraline for the post natal period as this is better for BFing. I did have a bit of trouble convincing the paediatrician in the hospital that it was OK to BF and take ADs though, and had to basically tell her to call my psych to discuss it, even though he had written a letter that was in my notes!

I would suggest asking for a referal to a perinatal service and make sure that all departments are talking to each other, and that you have someone with you after the birth who can advocate for you. My lovely DH, who had been up all night, bless him hmm, fell asleep and left me, exhausted, hormonal and coming off the post birth high, trying to fend off two paediatricians who were trying to force me to bottle feed to get his blood sugars up and because they thought it wasn't safe. thankfully I had a fabulous midwife who was fighting my corner for me.

In the meantime, there is some information from LACTmed on fluoxetine, paroxetine and sertraline. It's worth pointing your HCPs in the direction of this site.

Good Luck, and I hope you are feeling OK smile

LackaDAISYcal Wed 07-Jul-10 20:43:44

I only changed to the sertraline after a lot of consideration with my perinatal psych as well. the bottom line is that it is possible to be pregnant and on ADs and also possible to BF and be on ADs and that it is better for a child to be BF and have minial exposure to the drugs than for them to be BF.

There is alot of information from The Breastfeeding Netowrk, but I'm having problems linking the site at the moment.

GinaFB Thu 08-Jul-10 09:39:37

Thank you ladies for all your posts and links etc. Its a minefield out there...

I am seeing my GP on Monday and will get her advice. It seems to me that as I am on such a low dose that I might be better off trying to come off it altogether it would solve a lot of problems. I am hoping that I could time it to approx 12/13 weeks with 2nd trimester symptons settleing down it might be the right time......

LackaDAISYcal thanks for the advice. So far the advice I have received from my GP & MW has been contradictory and so very confusing! Its so useful to hear from someone who has been through it! x

podmumlet Fri 03-Dec-10 15:03:36

Thanks for posting this informative thread GinaFB.

I am due January and in a similar situation to you... Are you still on the fluoxetine, and have you decided whether you are wanting to breastfeed the new baby? Have you been advised to switch ADs?

Hope all is going well - February is almost upon us!

NeedToSleepZZZ Fri 03-Dec-10 18:39:35

Hi podmumlet, I have just gone through prozac withdrawal (30 weeks pg) without any real side effects. I was told by my psychiatrist that there was a risk baby could be a bit small because of it so am having growth scans (ironically I'm measuring further along than I should). I was also told that it wasn't a good idea to bf if I took it so I decided to stop.

However, my doctor has reminded me that if I start to get low again then I should start it again. It's a case of weighing up the risks and benefits.

Hope you are doing well, January is even closer!!! smile

jellyhead188 Fri 03-Dec-10 18:44:25

Hi - I was told that I mustn't take it during pregnancy as risk of heart problems to the baby but that if I did decide to take it then I must come of it at about 7 months otherwise the baby would be born addicted to it. I was told I could not breastfeed while taking it!

Fortunately I came off it before I fell pg and been ok so far, but I've been told I can take beta blockers (I suffer with anxiety) if I need to when I'm breastfeeding.

However, my sis in law was told she was fine to take it throughout her pregnancy - but not breastfeeding I think. xx

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