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  • Starting new antidepressant

    Prior to pregnancy I was on Prozac for depression. I came off of it during the pregnancy. Due to my history with depression I decided to avoid post partum depression that I would go back on an antidepressent right after her birth. I was put on 25 mg of zoloft and after a week experienced severe panic attacks and insomnia and an abnormal heartbeat. I came off of it immediately. However, I did like the calming affect zoloft had on me when I first started taking it. Paxil and Lexapro have been suggested as other options to treat my Post Partum Anxiety and Depression. I'm at a loss and am worried about side effects as well. I don't feel comfortable with going back on Prozac until she's older. She is now 5 weeks. I am curious what age is considered an older infant. And what might be a good option for an antidepressant/antianxiety?

    Thanks for your time and expertise!

  • #2
    Dear eleighhaynie,

    Lexapro and Paxil are also Selective Serotonin Receptor Inhibitors, just like Prozac thus they are similar in actions and side effects. That being said, their exact mechanism is not understood therefore one SSRI may work for someone whereas another may not have the same therapeutic effect. Since you have had success in therapy in the past with Prozac, we would recommend that you discuss continuing that therapy with your doctor. The half life of this medication is long (2-3 days), but it is important to note it also has an active metabolite that remains in the body for 13 days. Most of the Prozac is protein bound (94.5%) and therefore not able to pass freely into breastmilk. We would recommend discussing with your doctor about titrating up to effect as compared to starting at a higher dose as is done often with anxiety disorders. You should always monitor for the side effects of medications and with Prozac these side effects include colic symptoms, and poor feeding. Prozac is rated as an L2, which means that most people have done well on it and there is minimal if any harm to the child during breastfeeding. Should you have any further questions, please call our InfantRisk Center at (806) 352 2519.

    Areeba Anam, B.S., M.S,
    LECOM Class of 2013 PharmD. Candidate
    Last edited by cpride; 02-13-2013, 01:47 PM.

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    • #3
      So, Prozac is an L2 drug for a young infant like mine? I had read that it was an L3 drug until the infant was older and then it was considered L2. Also, I have been trying to just used Saint John's Wort. But it isn't working as well. Do I have to wean myself off of it before I start Prozac? Why was Prozac considered an L3 drug in older literature for young infants? My baby is 5 weeks old.

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      • #4
        Dear eleighhaynie,

        Prozac is now considered an L2 as compared to an L3 because we have more research now as compared to its previous designation. The L3 risk category means there are no controlled studies in breastfeeding women; however, the risk of untoward effects in a breastfed infant is possible, or controlled studies show only minimal non-threatening adverse effects. Drugs should be given only if the potential benefit to the mother justifies the potential risk to the infant. New medications that have no published data are automatically categorized in this category, regardless of how safe they may be.

        St. John's Wort (SJW) is an herbal medication that is often used for depression. Breastfeeding studies are rather weak, but suggest minimal transfer of SJW into human milk. This product is probably safe to use in breastfeeding mothers. However, the drug to drug interactions are significant and may reduce blood plasma levels and effectiveness of many medications by 50 % or more; therefore, we would recommend that you discontinue the Saint John's Wort before beginning treatment with Prozac.

        Areeba Anam, B.S., M.S.
        Pharmacy Candidate Class of 2013- LECOM School of Pharmacy

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