Prozac during pregnancy

Naomi Carr
Author: Naomi Carr Medical Reviewer: Morgan Blair Last updated:

Depression is a common condition that can impact mood and functioning. Many people experience depression before, during, and after pregnancy and may feel concerned about how medications affect their baby’s health. It is important to continue or start treatment for depression during pregnancy, and many safe options exist.

Is it safe to take Prozac during pregnancy?

Fluoxetine is an antidepressant medication in the class known as selective serotonin reuptake inhibitors (SSRIs). One of the brand names of this medication is Prozac, which is a commonly prescribed medication used to treat depressive disorders, anxiety disorders, and other mental health conditions [1].

When becoming pregnant, many people worry about the impact of continuing or starting Prozac treatment, fearing it may harm their fetus. Despite some studies suggesting increased fetal harm with antidepressant medications, it is generally considered safe to take Prozac during pregnancy, as these risks are minimal [2][3].

Furthermore, studies show that untreated depression in pregnancy can cause harm to the fetus, so medication is typically recommended if symptoms are moderate to severe. Similarly, suddenly changing or stopping medication while pregnant can cause withdrawal symptoms, relapse, or worsening symptoms [4][5].

As such, it is often recommended to utilize medication treatment to manage symptoms of mental illness during and following pregnancy. It is always advisable to consult with your doctor before changing or stopping medication, especially when pregnant. If you wish to stop your prescription, it is advisable to do this gradually and with the advice of your clinician [6].

How does Prozac affect the fetus?

There is limited clarity on the effects of antidepressant use during pregnancy. However, several studies have looked at individuals already taking medications such as Prozac before and during pregnancy and those who choose to change or stop medications during pregnancy [7].

Within this type of research, it is not clear whether prior risks of mental illnesses such as depression contribute to issues in pregnancy and newborns or if medications cause these issues. As such, research into the use of Prozac and other antidepressant drugs during pregnancy is a controversial topic with many disputed results [1].

Heart

Some studies suggest that using fluoxetine during the first trimester of pregnancy may increase the risk of heart issues and abnormalities in newborns. However, this increase in risk has been disputed, as other studies have found no increased risk of heart defects associated with fluoxetine use in the first trimester [7][8].

Lungs

Similarly, some studies suggest that exposure to fluoxetine in the second half of pregnancy may increase the risk of persistent pulmonary hypertension in newborns, which causes issues with breathing. Again, the existence or impact of this risk has been disputed. In studies that have found a risk, it has been shown to be below 0.4% [1][5].

Withdrawal

In a small number of cases, newborns exposed to fluoxetine late in pregnancy may experience withdrawal symptoms, often referred to as poor neonatal adaptation (PNA). This can include irritability, increased crying, and reduced sleep and appetite. Generally, when these symptoms occur, they are mild and reduce within several days without needing treatment or intervention [1][7].

Early delivery and low birth weight

Prozac and other SSRIs have been linked to an increased risk of preterm delivery and low birth weight, particularly with higher doses. Babies born early or with low weight may be at higher risk of experiencing health issues [2][9].

However, this risk is also increased in mothers with untreated depression. Therefore, it is unclear whether the use of medications, the presenting mental health condition, or other factors are responsible for this increase in risk [4].

Other risks

Some studies suggest an increased risk of impairments in cognitive and emotional development and mobility in infants exposed to fluoxetine or other antidepressants during pregnancy. Generally, it is believed that the risk of these impairments is impacted more by mental illness, particularly depression, than medication use [2].

Some research indicates a link between the development of autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD) and the use of SSRIs during pregnancy. However, when other contributing risk factors are accounted for, particularly mental illness and genetic factors, it is widely believed that medications are not responsible for an increased risk of these conditions [1][4].

Is it safe to take Prozac while breastfeeding?

Medications can pass into breast milk in small quantities and, thus, be transferred to infants. As such, there is a small risk of side effects in breastfeeding babies, although this risk is considered minimal. These adverse effects may include irritability, diarrhea, vomiting, and reduced sleep. This risk is thought to be more likely to affect younger newborns than those over two months [1][5].

Some studies have found that babies exposed to fluoxetine through breast milk show normal physical and mental development. As such, the use of Prozac while pregnant is generally considered to be safe, although it is advised to monitor infants for any concerning changes in their physical or mental state [1][3].

Fluoxetine has been found to pass into breast milk in slightly higher amounts than other SSRIs, so it may be preferable to choose an alternative medication if treatment has not commenced before pregnancy. However, it is not advised to change medications during pregnancy or breastfeeding, so if Prozac is already used, it is recommended to continue this treatment [3][5].

Often, the benefit of taking Prozac far outweighs the potential risk of harm to the newborn. Depression can cause impaired functioning and self-care, potentially causing risks to the mother. Similarly, it can reduce abilities to provide adequate care to the baby or for mother and infant bonding, which may cause impairments in development and health [2].

Alternatives to Prozac while pregnant

Medications

If symptoms of depression or other mental illnesses are mild and manageable, starting medicinal treatment during pregnancy may not be necessary. Similarly, if a very low dose of Prozac is prescribed, it may be possible to reduce or gradually stop this prescription with minimal impact on mental well-being [6].

However, if symptoms are moderate to severe or have persisted for a long time, it is advisable when pregnant to continue treatment that has already commenced or to start a new treatment if required.

Untreated depression can cause issues during pregnancy, such as unhealthy behaviors, including alcohol consumption or cigarette smoking, suicidal ideation, and poor self-care. These issues can cause severe harm to the fetus and mother, so they must be treated to ensure safety and well-being [2][4].

If a medication is already prescribed, it is advised not to change or stop this treatment. As such, it is not recommended to find alternative medications if Prozac treatment was started before pregnancy unless advised by a doctor [6].

If a medication has yet to be prescribed, a doctor will discuss the options with the parents so that effective and suitable treatment can commence. Generally, other SSRIs, such as citalopram and sertraline, are effective and safe during pregnancy [8].

Similarly, other antidepressants, such as tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and mirtazapine, can be safe to use during pregnancy with minimal risks. The antidepressant prescribed will likely depend on mental and physical health history, symptoms, and medication response [5][7].

Non-medicinal treatments

Whether alongside or instead of medication, other treatment options can be beneficial when managing symptoms of depression, anxiety disorders, and other mental health conditions during pregnancy, such as [5][6][7][8]:

  • Therapy: Psychotherapy, such as cognitive behavioral therapy (CBT), can help to reduce symptoms, manage emotional distress, and learn positive coping strategies.
  • Groups:Many mothers find peer support groups helpful during or after pregnancy, as this can provide support and advice, reduce feelings of stress, isolation, and low mood, and provide an opportunity to share experiences.
  • Mindfulness: Mindfulness techniques, including meditation and yoga, have been found to reduce stress, anxiety, and depression. These types of exercises can also be beneficial in reducing physical tension and pain, further improving mental well-being.
  • Self-care: Maintaining self-care during and after pregnancy is vital for the well-being of both mother and baby. This can include consuming a nutritious diet, getting enough sleep, and utilizing relaxation and breathing exercises. Similarly, it is advised to avoid substances that can worsen symptoms, including caffeine, nicotine, alcohol, and drugs.
Resources
  1. Mother To Baby: Fact Sheets. Fluoxetine (Prozac®).(2022). Brentwood, TN: Organization of Teratology Information Specialists (OTIS). Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK582711/
  2. Dubovicky, M., Belovicova, K., Csatlosova, K., & Bogi, E. (2017). Risks of Using SSRI/SNRI Antidepressants During Pregnancy and Lactation. Interdisciplinary Toxicology, 10(1), 30–34. Retrieved from https://doi.org/10.1515/intox-2017-0004
  3. National Health Service. (Reviewed 2022). Pregnancy, Breastfeeding and Fertility While Taking Fluoxetine. NHS. Retrieved from https://www.nhs.uk/medicines/fluoxetine-prozac/pregnancy-breastfeeding-and-fertility-while-taking-fluoxetine/
  4. Jahan, N., Went, T.R., Sultan, W., Sapkota, A., Khurshid, H., Qureshi, I.A., & Alfonso, M. (2021). Untreated Depression During Pregnancy and Its Effect on Pregnancy Outcomes: A Systematic Review. Cureus, 13(8), e17251. Retrieved from https://doi.org/10.7759/cureus.17251
  5. Wichman, C.L., & Stern, T.A. (2015). Diagnosing and Treating Depression During Pregnancy. The Primary Care Companion for CNS Disorders, 17(2), 10.4088/PCC.15f01776. Retrieved from https://doi.org/10.4088/PCC.15f01776
  6. Osborne, L.M. (n.d). Antidepressants and Pregnancy: Tips From An Expert. Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/health/wellness-and-prevention/antidepressants-and-pregnancy-tips-from-an-expert
  7. Yonkers, K.A., Wisner, K.L., Stewart, D.E., Oberlander, T.F., Dell, D.L., Stotland, N., Ramin, S., Chaudron, L., & Lockwood, C. (2009). The Management of Depression During Pregnancy: A Report from the American Psychiatric Association and the American College of Obstetricians and Gynecologists. Obstetrics and Gynecology, 114(3), 703–713. Retrieved from https://doi.org/10.1097/AOG.0b013e3181ba0632
  8. Mesches, G.A., Wisner, K.L., & Betcher, H.K. (2020). A Common Clinical Conundrum: Antidepressant Treatment of Depression in Pregnant Women. Seminars in Perinatology, 44(3), 151229. Retrieved from https://doi.org/10.1016/j.semperi.2020.151229
  9. Chambers, C.D., Johnson, K.A., Dick, L.M., Felix, R.J., & Lyons Jones, K. (1996). Birth Outcomes in Pregnant Women Taking Fluoxetine. The New England Journal of Medicine, 335, 1010-1015. Retrieved from https://doi.org/10.1056/NEJM199610033351402
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Naomi Carr
Author Naomi Carr Writer

Naomi Carr serves as our talented writer, dedicated to raising awareness about mental health and providing support to those in need.

Published: Jul 20th 2023, Last edited: Sep 22nd 2023

Morgan Blair
Medical Reviewer Morgan Blair MA, LPCC

Meet Morgan Blair, our accomplished medical reviewer. Morgan is a licensed therapist with a master’s degree in clinical mental health counseling from Northwestern University.

Content reviewed by a medical professional. Last reviewed: Jul 20th 2023