Is Prozac unsafe?

[Jayna's Mama]

I was switched to Prozac for my depression before I became pregnant, as my Doctor said it was the safest. My daughter is now 2 1/2 month and ebf and I am starting to hear that Porzac if not okay for nursing moms?

Any thoughts?

[jtherese]

Prozac

Many people will tell you that any of the SSRI's are safe for bfeeding mothers. And, it's true, that there is anectodal information from mother's that take them during pregnancy and while breastfeeding. Many report little or no side effects. Though, as you can imagine, there are some side effects that have been reported (even on SSRI's, some children have been born adicted to the medication and have had the DT's).

The problem is that we don't do clinical trials on pregnant women. There are no long term trials of breastfeeding women on medications because it would be unethical to set up that kind of experiment. It's also hard to find a pool of willing breastfeeders who want to be part of a double blind trial. For the same reason.

We do have some clinical trials that observe and test infants of breastfeeding mothers. They are not long term. Of those, there have been some adverse reports of side effects (colic among them). But long term side effects are not yet understood or studied. They do know that all of the SSRI's can be found in breastmilk.

Although I try to keep up with the literature, I know of no clinical trials that can offer (what I consider) real help in this situation. They are simply not long term, which is what we need.

Most MD's try to weigh out risks. If you are very depressed, and need help, then it might be essential for you to take a medication. If you are able to utilize other supports, and not 'clinically' depressed, than it might be possible for you to not take a medication.

The real question is for you, I think, since you know what it might be like off of the medication. If you would feel so depressed and/or unsafe that you cannot parent (and parent safely) then a medication might be a good choice.

[Jayna's Mama]

I am feeling like I want to go off the meds. ( I would do this under a watchful eye of course)

I started on anti-depressents after a misscarriage and infertility problems. Not having a baby was sending me in a tail spin, all I ever wanted was to be a mom.

Now that I have my daughter I am in total bliss, granted she is only 3 months old, but I have never been so happy in all my life. I love being a mom.

So I wonder if not being a mama was the cause of a bit of my blues?

Maybe I should find out about going off the drug....

[Ruthla]

My understanding is that no meds are 100% safe, especially while pg and/or nursing. I don't beleive Prozac is any more or less safe than other similar meds. It's a question of risk/benefit- is the risk of using the drug greater than the risk of not using the drug? In many cases, the theoretical risks of drug side effects are less severe than the risks of untreated depression- poor sleep and nutrition can directly affect a fetus, a mother who's less "with it" interacts less with her baby and might be less able to prevent a crawling baby or toddler from getting into an accident.

[jtherese]

Titration

My only advice would be to consider (with your MD) a very slow titration schedule. While it's true that some folks do well with a typical titration schedule, many others suffer what is called a 'rebound effect.' Ask you MD about this.

Mainstream MD's will titrate you in a way that is physically safe. So, you don't get off the med completely, but rather reduce dose until - perhaps after six weeks - you can completely go off the med.

There is some research (research that I like) that says that some folks need a much longer titration (in some cases months). You can do a lit review of rebound effect and see quite a bit of literature on it.

The rebound effect hypothesis (and I find it compelling) says that the reason so many people come off their meds and then feel terrible is not, as they then assume, that they need the medication -- but that that their body misses the med. And they 'rebound.'

That makes sense. It happens to me with coffee, afterall.

Anyway, I just wanted to toss it out there. It's becomming a more and more researched topic, so you should find quite a bit of information.

If you do chose to titrate your meds, remember to boost your supports, stress management -- particularly in the short term as you are adjusting.

Good luck!

[Jayna's Mama]

How do I titrate my meds? I am already on the lowest possible dose.....

[jtherese]

Titration

You'll really have to approach your MD about what kind of schedule is safe and for how long. If you were to consider a slower titration schedule, you could raise it with her/him.

When people titrate a pill, you go down in small incremental doses. Sometimes people cut pills in half.

The 'rebound' literature is interesting because it says to titrate even slower than MD's usually do.

Of course, some folks get off meds, have some minor problems adjusting, but are otherwise fine. It's the other folks (who make up much of my experiences) who go off a med, feel awful, and then say: I've learned my lesson, I really need it.

Which may be true. Or it may be the rebound effect.

But I'd start with my MD. There may also be some information on the internet to review and see what you think. I know that there is increasing literature in the medical journals, so look there, too.

You may very well be someone who doesn't need a slower titration schedule. But it's something to consider.

j

[Jish]

Have you ever missed a dose of your med? When I was on meds the first time and was wanting to try to go off to get pregnant (I had been on them for nine months) I was worried about the side effects that you hear horror stories about when people try to wean off their meds. My doctor asked me if I had ever missed a dose of my med, and how I felt. In my case I had missed a dosage or two on many occasions (I am on them again after the third child and miss doses or two all the time, sometimes more. ) For me I didn't notice a darned thing on the days I missed a dose. I didn't feel anything physically or emotionally. I have friends who would know by 2:00 in the afternoon if they had missed their morning dose because they would feel "funny." They might feel shaky or headachy, or whatever, but I never have had any of that.

My shrink said that since I had missed doses without any symptoms that I would likely be able to easily go off the meds and he was right. He told me to cut the pills in half for three or four days, then for the next three or four days to take the half dosage, but only every other day, then quit. I totally weaned off them in four days with absolutely no effects. I felt the same as always. My mother, who was taking 80mg of Paxil (which is supposed to have some of the nastiest withdrawls of the ssri's) quit cold turkey with absolutely no problems.

It is different for everyone, obviously, but try not to worry too much about what side effects you will feel, or I guarentee, you will feel them all. :LOL Be positive, you will know if you need to go slower.

Do remember that your hormones are still very much in flux and will be for a while. My ppd doesn't kick in until about two months before I get my first post partum period, usually around the time my kids turn a year old. If you go off successfully now, that doesn't mean that it won't creep back in sometime in the next year or two. Good Luck!

[Jayna's Mama]

I have missed days before and I don't notice anything. I will tlk to my dr. and see what they think.

[EllasMama]

From what I have been told, including from one health professional who really knows the subject, the 3 antidepressants considered safest for breastfeeding and pregnancy are Zoloft, Celexa, and Prozac. So although the drugs are relatively "new" and no long-term studies have been done, the short-term studies indicate that those three are excellent choices for mamas in need of antidepressants.

A friend told me that Prozac is one of the easiest antidepressants to wean off of b/c it is eliminated from the body more gradually than many other a/d's. So between that and titration, it should be less shocking if you decide to go off. Do be watchful for signs of depression returning and don't feel bad if it happens that you need to take something a bit longer.

Warmly,
Carol

[Greensleeves]

From what I've read Zoloft is usually a better bet for taking while breastfeeding, because it has a shorter half life. (Stays in the system less time.) Also less gets into the breastmilk. So if you wean off the Prozac but think you may need to go back on something (hopefully not), you could try Zoloft.
Prozac has a longer half life, and gets into the breastmilk in greater amounts.
I got my info from "The Ultimate Breastfeeding Handbook" by Dr. Jack Newman. But I've also read similar recs on the Kellymom site from a lecture by Dr. Hale at LLL conference.

If you do decide to wean off the a/d's, I would do it really gradually. I took an a/d for about 6 months a while back, and I regretted weaning from it so abruptly.

[Jayna's Mama]

Thanks for all the wonderful advice! I am going to weigh the pro and cons, because I want to be the best possible mama for my babe, but don't like the fact that she may be receiving some of the meds. I am going to ask at my LLL meeting also.

[Jish]

The university in my town did a study a few years ago with nursing mothers taking antidepressants. I had several friends who were in the study. For all of them, the results were the same (regardless of the med they were taking.) The med showed up in trace amounts in the milk, but when they tested the babies blood, it was undetectible in the blood. That doesn't mean that it wasn't there in tiny amounts, but it was undetectible. I thought those were pretty good results and made me feel pretty good.

There are so many things to worry about when breastfeeding, heck, there was all that press last year about chemicals found in mothers milk and how that effects babies. It seems like we just can't win sometimes. : If you need the meds, try not to worry about her getting the med. If you are depressed or anxious, she is getting the stress hormones from you through your milk and those aren't good either. See what I mean, we can't win. :LOL

[Greensleeves]

Jish,
That is a really good point about the stress hormones. I wish I would have used more relaxation techniques with both my pregnancies, and possibly used a/d sooner in this one. My dd was colicky and high needs and I always wondered if it was partly from me being so stressed out during my pg. She's just a doll now and so smart, but still I don't know if she'd be calmer at times if I'd had a calmer pg.