Is Prozac (fluoxetine) a safe anti-depressant for pregnancy?

"If you are on medication for depression it is best to speak to your doctor before stopping or changing any medication whether you are pregnant or planning to conceive," urges MFM’s GP Dr Philippa Kaye.

"Suddenly stopping a medication such as Prozac can lead to withdrawal reactions which can include diarrhoea, headache and sweating. Your doctor will discuss the risks and benefits of staying on the medication and often it is decided that staying on the fluoxetine is the safest option but do speak to your team first. If it is decided to avoid fluoxetine an alternative medication can be given."

The current NHS advice states that as 'a precaution, antidepressants are not usually recommended for most pregnant women, especially during the early stages of a pregnancy', but that 'exceptions can be made if the risks posed by depression (or other mental health conditions) outweigh any potential risks of treatment'.

What is Prozac?

Prozac, or fluoxetine hydrochloride, is one of a number of commonly prescribed SSRI anti-depressants to help relieve the symptoms, which might include crying a lot, feeling moody, having no energy, sleep or eating problems, and withdrawing from family or friends.

Prozac is regularly prescribed for depression and anxiety, as well as other mental health issues such as obsessive compulsive disorder (OCD) and eating disorders like bulimia.

In pregnancy, and post-birth, the massive physical, emotional and lifestyle changes can mean that depression is more likely to rear its head.

So is there a downside of Prozac?

A recent study by Columbia University Medical Center and the New York State Psychiatric Institute, evaluated the data of over 840,000 women and established a link between taking SSRIs and a "lower risk of preterm birth and Caesarean section" Dr Brown, professor of Psychiatry and Epidemiology said that this "further confirm the results from previous research of a higher risk for several neonatal problems."

Another study of 18,000 women, published in the British Medical Journal, compared women who took anti-depressants and had a child with brain malformations and heart defects, with 10,000 women who didn't take any drugs and whose babies didn't have any problems. The concluded that although there is a risk, it is still very low. “Although our analysis strongly supports the validity of the associations that were observed, the increase in the absolute risks, if the associations are causal, is small,” the researchers concluded.

In addition to this, some (but not all) studies have found a higher than average risk for low birth weight and premature delivery when antidepressants are taken during pregnancy, especially in the last three months.

There’s also the likelihood that in late pregnancy, the effects of the drug may be passed onto the baby, who could have withdrawal symptoms after birth.

But, a doctor will weigh up the risks to the baby against the dangers of depression to the mum-to-be, particularly as depression itself can affect the unborn child.

This can be because depression can affect a mum-to-be’s ability to eat properly, follow medical instructions, and attend antenatal appointments – or mean there’s more chance of turning to illegal drugs or alcohol.

A potential alternative

Research into an alternative to pills has been led by Deborah Kim, MD, assistant professor of psychiatry, University of Pennsylvania, in Philadelphia. The small study into the use of "TMS (Transcranial Magnetic Stimulation) has shown positive results. "TMS is good for women with moderate to severe depression who don't want to go on antidepressant drugs," says Dr. Kim. Although the studies are in their early stages, it's good to see there is a potential alternative.

Mums on our forum say

"I'm currently ttc and have been taking 40mg prozac per day for years now for severe depression and anxiety. Doctors say the risk of me being depressed without my meds would be worse for me and a baby than the risk of staying on the prozac so I'm staying on it." scribble

"I was prescribed [citalopram] in my last pregnancy, I was advised it was completely safe in pregnancy and breastfeeding, however, I didn't get on with the drug. I've since started Prozac (fluoxetine), which is working wonders for me, and then I discovered I'm pregnant. I was told that its safe when the risks are far outweighed by the benefits (as in my case) however, there is a chance the baby would suffer withdrawal. I intend to breastfeed, and so my doctor has advised me to wean off them around the 7/8 month mark and if I need help postnatally, they will give me something better suited to breastfeeding." Bex78

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