four and a half months.. switching form paxil to prozac??

1803 Views 8 Replies 8 Participants Last post by Princess32, Apr 14, 2006

Princess32

Discussion Starter · Apr 13, 2006

Hi everyone,
I am a new member who needs your help and guidance on an issue.

I am four and a half months pregnant. I have been taking Paxil for almost four years (except for a few short months when i was on Lexapro. Bad choice.). I have taken Paxil throughout my pregnancy, and am now four and a half months along. Today, my doctor told me that she wants to take me off paxil,and put me on Prozac for the rest of my pregnancy, because it is safer. Here is my thing: Because of how severe my depression etc is, I am afraid I will do more harm than good to the baby. So..

1) IF I want to get off paxil now, and start on Prozac, what is the best way to do it?
2) For someone like me, should or can i consider taking paxil throughout my pregnancy?
3) What are the risk if I continue to take paxil throughout my pregnancy?
4) Also, has anyone had a similar situation, and how did you deal with it?

This is my first child.. I only want the best for him or her, but I do know that alot depends on my emotional wellness (giving him or her the best health wise).

Thank you ladies for such a wonderful board..

.

Princess

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babydoll

· #2 · Apr 13, 2006

Paxil is no longer considered safe for pregnancy or breastfeeding. Prozac, Zoloft, and Lexapro are the ones most commonly prescribed. Zoloft is supposed to be the safest for breastfeeding if you plan to. Also, it would probably be better to make the change now so that you are acclimated to the new drug before the baby comes and you are hit with postpartum hormones. Good luck to you!

You can breastfeed on antideppresants. A good site is Dr. Thomas Hale's website. YOu can join as a visitor. He is considered the guru of breastfeeding pharmacology.

http://neonatal.ama.ttuhsc.edu/lact/

Babydoll

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*guest

· #3 · Apr 13, 2006

I believe Paxil has been linked to neonatal seizures and heart issues, but you can Google Paxil pregnancy safety and find all the articles. This site is a good resource as well: http://www.womensmentalhealth.org/
I would personally switch to Prozac if being on meds is a must. I've taken Paxil in the past when not pregnant, and the withdrawal can be very difficult. I wouldn't take it again, knowing what I know now. I'm not sure about the extended release formulas they have now. The older formulas (which is all I personally have experienced) required slow tapering to avoid SSRI discontinuation side effects. It's possible to start a very low Prozac dose at the same time as you begin to taper the Paxil, if you're on a formula that might require tapering. If you are not already seeing an actual psych-pharm doctor, I'd encourage you to find one rather than rely on a GP. Or if your psych-pharm person is not experienced in pregnancy, ask for a referral to one who is. If you're near a larger university, they may have clinics devoted to treating women and pregnant women.
You may also want to check out the Postpartum Depression threads in the Pregnancy and Birth area of the forum. The topics are not all post-partum related, although your choices now will most likely affect your post-partum experience. Good luck with whatever you decide.

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ibex67

· #4 · Apr 13, 2006

I used Zoloft from my third trimester on and nursed my son for 4+ years while taking it. It was recommended to me by my Dr over Prozac because Zoloft has a much shorter half-life in the body than Prozac does. There is concern that the Prozac accumulates in the newborn liver because of it's longer half-life and the fact that a newborn's liver isn't very efficient yet.

This time during my pregnancyI am using Celexa. There has been some discussion with my midwife about switching me to Zoloft in the 3rd trimester because some newborns experience some withdrawal symptoms post-partum when their moms are on Celexa. Not sure what I will do yet. Zoloft doesn't work for me as well.

My understanding is that Paxil is NOT a good choice -- and if I were you I would switch from Paxil to Zoloft. Of course you need to ramp down the one while ramping up the other, but a good psychiatrist should tell you exactly how to do this.

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Snowdrift

· #5 · Apr 13, 2006

Since your depression is quite severe, perhaps talk to your doctor about a brief inpatient stay while you make the switch? In my own experience, switching meds while in the midst of a serious can be dangerous, but in your case it seems warranted.

If you have access to a good hospital, being inpatient will allow not only for increased monitoring of your condition but also additional therapy and a low-stress environment which should minimize any problems with switching.

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oregongirlie

· #6 · Apr 13, 2006

Just wanted to restate the withdrawl issues. Make sure, sure, sure you taper off gradually from the Paxil. Also, I've found that reducing my responsiblilities (when possible) helps with depressive symptoms a lot. Take good care of yourself and good luck.

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Jish

· #7 · Apr 13, 2006

I have a friend who switched from Paxil to Prozac (not preg at the time) and she did it by adding a small amount of Prozac while dropping a small amount of Paxil. It took her several weeks to make the full switch (I'm thinking 4 to 6) by slowly upping her Prozac dosage and lowering the Paxil dosage until she was off the Paxil and on the full dose of Prozac.

I have a friend who is a child psychiatrist and he says the current recommendation is that it is best -- if possible -- to go off the meds two or three weeks before you expect to deliver to give the fetus a chance to go through withdrawl in utero where it is gentler, and then to restart right after delivery. Breastfeeding doesn't pass nearly the amount of med, so even if you breastfeed, the babe will likely experience withdrawl because of the large drop in the med s/he experiences. But, if that isn't possible, staying on the meds is the best option for you both.

I know many people who have gone through pregnancies on a variety of different ssri's and even one who did it on tricyclics (the old fashioned antidepressants of years ago) and their children are healthy and thriving. There are risks and benefits of everything and you have to make the choice that is best for you and your child. I am very lucky that I am able to go off my meds while pregnant and for about the first year after the baby arrives, but about two months before my period returns -- whammo -- it's back. I have gone into my pregnancies realistic, though, and would go back on the meds even while pregnant if I needed to.

I wish you the best of luck with the switch, and with your babe to be.

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chrissy

· #8 · Apr 13, 2006

hi princess,

this is such a difficult situation to be in. i have been on paxil (20 mg) for severe anxiety for over 6 years. i took it throughout 2 full term healthy pregnancies and nursed both of those babies long term (i'm still nursing the youngest now). neither of my children experienced any withdrawl symptoms upon birth. i also was taking paxil when i had my miscarriage a few weeks ago. i will note that my son has a heart defect, but not one that has been linked to paxil.

very recently i tried to taper off of paxil. i was getting acupuncture, taking chinese herbs, and decreasing slowly. it just didn't work though and i have just started taking it again. i feel guilty and somewhat ashamed because i do want to get pregnant again quickly and i wish i could manage without paxil, but i just can't.

here is one study i found about the concerns of paxil in pregnancy: http://www.medicinenet.com/script/ma...ticlekey=57323

hale doesn't seem to have any specific concerns with it for nursing moms.

i think this is one of those decisions that only you can make for yourself, well with the help of your doctor that is. my psychologist was very wary of my quitting paxil. my husband was too. in the end i just couldn't handle it. i was irritable and anxious and could feel the panic and anxiety coming back full force. i know all that isn't good for my body or a future fetus.

best of luck to you mama.

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Princess32

Discussion Starter · #9 · Apr 14, 2006

thank you sooooo much ladies! I have considered all your responses. I am becoming more confident in what I think I will do. Either wean off and take the prozac at the same time, till i am completely off paxil and on prozac, or I will continue to take the paxil. I just can't afford to go cold turkey from one to the other. Thank you soooo much ladies. I am glad i found this site

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