Prozac and Pregnancy

[ClarasMummy]

To cut a long story short I have been suffering with severe depression, agoraphobia and anxiety for quite a long time now. I am currently 23 weeks pregnant and have been prescribed Prozac. I really don't know what to do, I'm just so worried that taking it will harm the baby in some way and I would never forgive myself, but on the other hand I have a 2 year old who is not being cared for adequately by me as a result of the depression and agoraphobia.
I just don't know what to do as I know I need to do something.

Does anyone have any experiences with pregnancy/breastfeeding and Prozac? I'm really in need of some reassurance.

Hi there ClarasMummy - was it a GP or a psychiatrist that gave it to you?

Prozac is an SSRI and there have been quite a few studies that show it is relatively safe in pregnancy, although of course they always give their disclaimer, that they cannot guarantee safety.

Have a read of this

Prozac seems to be one of the ADs of choice for pregnancy as it is one that has been studied the most during pregnancy.

However, it doesn't appear to be one of the best for b/feeding as it gets into the milk in fairly high concentrations - something like Sertraline would normally given during b/feeding.

One thing that really struck me from this website is that they acknowledge that depression in itself is not a "benign event" for the foetus - i.e. all the stress hormones etc. whizzing round your body could be harmful too. So just because you don't take a drug, to treat your depression, doesn't mean that will be the best outcome for either you OR your baby. It seems the consensus is that depression is serious and should not be left untreated.

The good thing in your situation is that you are already well past the first trimester, so the baby will already have done all its forming. Therefore the risks of you taking prozac are also probably lower.

I would trust your dr and go for it. You cannot carry on with severe depression and anxiety - it will not be good either for you or your baby.

I am in a similar position - on an AD but wanting to try for another baby. Wondering whether to come off it, and risk crashing myself, or worth the risk to stay on it and stay well throughout pregnancy. It's a difficult one. However, if I could get through the first trimester without taking anything (like you have done) I would be very happy and I think would have less fears about starting an AD.

Hope it goes well and you start feeling better very soon
x

Thank you for the advice GetDown, I was prescribed the Prozac by a Psychiatrist. The decision has been making me so stressed, I went to pick up the prescription yesterday and the pharmacist used the word "dangerous" to describe using Prozac in the third trimester. Needless to say I haven't taken it as a result, as the third trimester is getting pretty close for me.

I may just try and battle through until the baby is born, though it is getting harder and harder to care for my toddler in my current state of mind.

So now.

I think that is really out of order for the pharmacist to do that.

What business is it of his? It was your Dr. that prescribed it, not the pharmacist. Honestly that makes me really angry. He has added to the stress and worry of an already anxious and depressed pregnant lady

Please go back to your Dr. for some reassurance. As I said in my previous post, it is better for you AND your baby that your depression is treated. There is some evidence to say that if the depression is treated early, you are less likely to suffer PND too.

Perhaps you could ask for sertraline, instead of prozac? Would give you a bit more peace of mind, esp if you plan to b/feed.

He certainly did add to my anxiety. I was finally resigned to the fact it would be better for everyone involved for me to begin the medication but I just couldn't do it after my trip to the pharmacy, just came home in floods of tears and told DH what had been said, and it made him start to worry about it as well

I'm having a visit from the Psychiatrist on Friday so will ask for Sertraline as an alternative, I've heard that it's quite safe in pregnancy so am beginning to wonder why I was prescribed Prozac in the first place.

To be honest, the pharmacist seemed to be judging me a bit, i'll go somewhere else next time.

Thankyou

What an awful pharmacist, definitely don't go back there! And maybe even complain!

It honestly is not their role to be saying what you can and can't take.

Yes sertraline may be a better option. Hope the visit on friday goes ok.

Hello Clarasmummy and Getdown - I hope you don't mind me joining this thread? It's just that I too have been looking for advice on this issue. Im 9 weeks pregnant and on Sertraline for severe anxiety/depression so I'm relieved to hear it's one of the safer ones. However, before I realised I was pregnant I was prescribed Pregabalin (v dangerous for baby's neural tube development), diazepam (not safe either), beta-blockers (ditto) and zimovane sleeping tablets (ditto) as I was having a fairly spectacular breakdown and needed a lot of meds to stabilise me. I'm now incredibly worried about what all this has done to the early stages of foetal development. Won't have a dating scan for another few weeks but so anxious in mean time!
Clarasmummy - your pharmacist was deeply unprofessional in his comments. Totally disregard him, he's obviously just a jumped up frustrated wannabe doctor. I'm doubtful about some pharmacists' knowledge and training after one of them gave my DH potentially fatally wrong meds last month (disregarding the GPs prescription). Just go on what your psych says.
Good luck on friday.

hi there lifescomplicated sorry you have been through such a tough time, hope you are stabilising a bit now?

Please try not to worry about the drugs you have taken. The risks with all these things are very small. And remember there are natural risks anyway, so not necessarily to do with the drugs, even if something were to be wrong (which I doubt will be).

No point in worrying now (though I know it's hard - I am a terrible worrier!)

You hear of drug addicts who have taken goodness knows what all through pregnancy and their babies end up being fine. Even the drugs with known effects like lithium, for example, the risk is still only about 5% - so tiny really.

Thanks GetDownYouWillFall - that's good advice and wise words indeed. As the meds I was on are also used for epilepsy and are known to cause neural tube defects I got carried away thinking that they definitely will cause defects, rather then remembering that even though it's raised odds, the odds are still stacking in my favour.

It's ironic that you mention lithium as that's what my husband's on although all the docs so far haven't been able to find any research into effects on male gametes so I'm assuming that's nothing to worry about.

What about you? Have you reached a decision about whether to be on an AD when you try and conceive? It's a very tricky decision and one only you can make. I came off my long term AD last year when we first had a go at conceiving. Unfortunately (and this is only in my case) this is what led to my recent relapse, although I did enjoy a good period of 9 months of wellness after first ceasing them, so your plan of ceasing them (slowly with supervision) just before conception and for the 1st 3 months before re-introducing them could be a good possibility to look into.

Good luck with it and let me know if you want to chat further or want any advice or support.

thanks lifescomplicated (I like the name!)

Yes I was on lithium too, but managed to get off it back in May (thank goodness). I have been on a lot of medication since my severe PND 3 years ago, but one by one I have got off every drug.

It's the AD that remains now. I have reduced it really really slowly but find my sleep is terribly disrupted if I finally stop taking it. Going without sleep is entangled with all sorts of anxiety issues for me - my PND started off with me not sleeping, and it got so bad I ended up in hospital

I have huge fears now about insomnia, which unfortunately fuel the inability to sleep

I'm down to a quarter of my dose now of AD. Sleep is not great - seem to alternate between an ok night and an awful night.

I would dearly love to be medication free during pregnancy, and at least the first 3 months but just don't know if I can do it.

I go downhill very rapidly when I'm not sleeping.

It's frustrating because I don't actually feel depressed. Have got a happy home with loving DH etc etc. and when I've slept well I feel great. But without the sleep I just feel terrible.

I think I'm going to see if I can stabilise on this tiny dose and then maybe start TTC and see what happens. I am well aware that you don't always fall pregnant right away anyway so I may have a few more months to wean myself off.

And someone else on here mentioned that in early pregnancy you are often more knackered than usual, so I may be able to sleep better anyway (really hoping so).

The research I have done seems to suggest that the AD I take is relatively safe. It's a tricky one though isn't it?

Hi GetDown.

Gosh, reading your post was like looking inside my own head! We have almost identical experiences and triggers. I too have trouble sleeping (linked to and triggered by anxiety) and lack of sleep is my main trigger for a rapid slide into severe depression and accompanying paranoia, irrationality, hopelessness and panic.
It can feel like a hopeless vicious circle can't it? I'm very impressed that you've managed to reduce your dose of your AD so much, and to have come off all your other meds (espec lithium, which my husband has so far not been able to even reduce without negative effects). Are you doing this under guidance from a psychiatrist or similar? If so, do you have a good relationship with them where you can talk through the issues related to conception etc?

I am only on an AD now too (having had to cease my beloved sleeping tablets and all the other stuff when I found I was PG) and I was concerned about the AD's effect but I've been reassured that mine (Sertraline) is the safest to use in conception/pg. Is that the one you're on? If not, it might be an idea to see if you can taper off the one you're on whilst gradually introducing a low dost of Sertraline. It would just mean that you wouldnt be completely 'flying solo' without meds (which I dedided was more of a risk to the baby than anything else).

Since the Sertraline kicked-in (about 3 weeks after starting it) it's improved my sleep. I take it at night and perhaps it's just a placebo effect but my sleep is definitely a bit better. I hope it could work in the same way for you too.
You're right that early pg does make you tired too, so your body will ensure you sleep enough when you're pregnant.

I'm sure you've tried all the alternative remedies etc but if all else fails in the sleep department I swear by Valerian tea. It smells yuck but you get used to it and it lives upto it's name of 'natures valium'!

Sorry for the long post - I do waffle!

Hi there again LifesComplicated - you?re not waffling at all, I find it so helpful to hear from someone who has been through a similar ordeal. My understanding and empathy with mental health issues has grown hugely since I?ve suffered with this (never had any history before PND) All my RL friends seem to just cope and shrug off bad nights, but for me they often spell total despair and plunging into anxiety. The only way of breaking the negative cycle seems to be resorting to diazepam or zopiclone for a night or two, which obviously cannot really be done during pregnancy.

I hear your advice re, sertraline, but TBH I am absolutely terrified of the SSRIs. I was put on citalopram when I first got ill and I can honestly say it made me 100x worse ? the agitation, insomnia, panic, nausea and tremor/shakes that it caused sent me to rock bottom and I believe was the ?last straw that broke the camel?s back? eventually landing me a mother and baby unit. I vowed never to take the risk with that class of drug again.

The AD I?m on now is mirtazapine, a completely drug in the way it works. It has worked for me really well, sorted my sleep problem (when I was on the 15mg dose at least) helped my depression and anxiety. Much of the research says it?s fine in pregnancy, but because it?s a newer type of AD (out in 1996 I believe) they are reluctant to prescribe it in pregnancy. I feel like I could settle it in my own mind to take a low dose, but would only take 1 judgemental / shocked health professional e.g. midwife, pharmacist, who knew little about it, to send my anxiety and guilt sky-rocketing. It?s so difficult.

Yes I came off lithium and the anti-psychotic under guidance from a psychiatrist. TBH they weren?t that supportive, but I have proved them wrong because I have remained pretty well. I didn?t find lithium at all difficult to come off (didn?t notice any effects on sleep, mood etc.) The anti-psychotic was harder though, as yet again, my sleep was disrupted. But no, the lithium was trouble-free. I did it slowly over the course of over 5 months. What dose does your DH take?

I have seen a peri-natal specialist to discuss possible pregnancy, but I cannot be properly referred to her unless I actually get pregnant. So it?s a difficult situation to be in really. Don?t want to get pregnant, just so I can be referred to her only for her to say ?you shouldn?t be taking what you are taking?.

I have tried a lot of the natural remedies, as you say. I?ve had valerian tablets, but not yet tried the tea so perhaps that?s something else I should try. I drink calmomile tea in the evenings because it is caffeine free and supposed to be calming. Pretty much you name it, I?ve tried it though: homeopathy, reflexology, nytol, sominex, acupressure plasters, rescue remedy, lavender oil.. I dread to think how much money I?ve spent on ?insomnia remedies? !!

What sleeping pills were you on, and how did you find getting off them? I have taken zopiclone in the past but terrified of the dependency issue so never taken them for more than two nights in a row, unless it?s a real crisis. Even then I try to have a ?natural? night somewhere in between the bad nights. It?s so hard, the dr.s say ?oh you won?t get dependent? but it?s not them that is dealing with the hell of insomnia or the possible consequences of getting hooked on something. I know for me, the placebo / psychological attachment to taking a pill is huge, that has at least in part been the reason why I find it so hard to get off my ADs, so the thought of having to wean off something that is actually, physically addictive, is horrendous. Not a risk worth taking IMO.

Anyway this is getting long sorry. I am really glad that the sertraline is helping you. Hope you stay well. You are doing brilliantly just keep on hanging on in there ? one day at a time. Take care. If you want to carry on chatting please feel free.
xx

Hey again GetDown (love your name too btw!)

I can completely see the conundrum that you're in at the mo. It's a shame that you can't be reffd to the peri-natal specialist properly at this stage (being reffd after you've conceived is a bit like shutting the stable door after the horse has bolted, if you'll excuse the terrible cliched analogy!).

I'm so impressed by your strength whilst and since coming off the lithium and anti-psychotics (esp as the latter really affected your sleep). It's so scary to do things that might geopardise sleep when one knows that sleep is the 'gate-keeper' to one's sanity isn't it? I can get a bit OCD about getting enough sleep and about my sleep routines just because the very thought of not getting enough sleep makes me anxious - it sounds like you're just the same, and it's understandable considering what lack of sleep has done to us both in the past.

Like you I've tried enough alternative sleep aids to set up a quack doctor's surgery! On the run-up to my most recent meltdown I was using valerian tablets, chamomile tea, valerian tea, nytol, herbal nytol, rescue remedy, lavender oil, lavender spray, and then eventually diazepam and then zopiclone. Like you I only liked to take zopiclone when utterly desperate after a few sleepless nights, but by the time I saw a new doc (due to relocation) I'd become so seriously ill and delusional that my new doc just gave me a month's worth of zopiclone and diazepam and basically said 'knock yourself out consistently for a couple of weeks as the sleep will stabilise you and we'll deal with any dependency later'. Previous to this episode the prospect of that wouldve horrified me but I was so desperate for sleep/sanity by then that I could've kissed him.

It's a very difficult call though, for doctors and for us. It's a fine balancing act b/w breaking downward insomnia spirals and the possible consequences of the meds.

However, I'm pleased to report that I took zopiclone every night for 3 weeks and when I found out I was pg I was able to stop just like that and havent had any withdrawals. The baby will probably come out a complete junkie but as you said to me last week - just think of the actual drug users who abuse street drugs etc all through their pg and give birth to healthy babies! I used to be a homelessness project worker and met a lot of young homeless girls who were drinking high-strength cider, smoking weed and doing hard drugs right until their labours and insanely their babies were always healthy! . I've convinced myself that it'll be sod's law with me though and I'll be the responsible, vegetarian, healthy-living mum who'll give birth to a 3-headed monster just because of prescript meds in the first trimester!

Sorry, I digress. I think that if you can get by at the moment with only light sporadic use of the zopiclone/diazepam that's great, and got to be better for you than intensive use like I did. I really panicked when I found out I'd not be able to take zop or diaz for the whole pregnancy (my fail-safe sleep security blanket had been whipped away but touch wood it's been ok. I just still have a bit of trouble with early wakening but after a nervous breakdown, masters finals, unplanned pg and a house move I reckon that's natural!!

Gosh this is an EPIC! I bet you've nodded off by now. It's great to chat with you though about these issues, and if you want to talk further that'd be great. Take good care. xx

Nope not nodded off

I am sitting here agreeing with so much of what you?ve said.

Yes it?s frustrating to not be able to get a referral to the peri-natal specialist until I am actually pregnant, and it does feel a bit like shutting the stable door after the horse has bolted. I have emailed her a few times though (she knows me from when I had PND the first time) and she said she?d try and get some up-to-date info on mirtazapine in pregnancy / b/feeding. And I do have a CPN that I can talk to (although TBH much of the time just seems to be me making her coffee and chatting about life in general!!)

Please try not to worry about your baby. As you say, there are mums who just don?t care what they take or what they do to themselves during pregnancy, and seem to have healthy babies. And babies are enormously robust. My baby was a tiny little thing at 5lbs something, but she was such a fighter! It amazed me how strong she was and the survival instinct is just incredible. You are doing the best for your baby by staying well. Also eating healthily and looking after yourself more generally will give your baby the best possible start in life. The fact you care so much, will mean he / she will have a great mum.

I comfort myself sometimes by repeating what someone said to me early on ?you may not be a perfect mum, but you are the perfect mum for your DD?.

It?s great you had a doctor that was understanding like that. I think there is a lot of wisdom in what he suggested you do. Getting sleep is just SO important in stabilising your mental health. It?s fantastic you were able to stop so easily after 3 weeks use too?. That gives me hope also that early pregnancy perhaps will help me sleep naturally too?.

I laughed about your ?quack shop? for alternative sleep remedies!! Me too! You should see our bathroom cabinet I even went for a self-referral to the London Sleep Clinic on Harley street. The consultant thought I had restless leg syndrome. It may be part of the picture but I felt it could not explain everything I have been through.

I hope you have a good rest of the day, take care xxx