Multiple meds (Prozac and Wellbutrin)

[BookDoctor]

I have found this forum with the greatest relief after anguish about whether I can proceed to plan a pregnancy while minimizing any harm to a future potential fetus.
I am a successful professional 35 year old woman who has had severe anxiety and mild depression for a very long time. I tried to come off of all meds to plan for a pregnancy in advance and it was disastrous. With my psychiatrists support I am now back on Prozac BUT my problem is that I have the unfortunate side effect of Prozac making me extremely sedated and lethargic to the point where I can’t work well. In the past I have combined it to some effect with Wellbutrin. My psychiatrist assured me that both Prozac and Well buttrin carry relatively low risks given the benefits for my own health, but I am so worried about being on not just one but two drugs. Is there any reason to suspect they would interact to cause more harm to a fetus or can each one be assessed independently? Is it at all common for a woman to be on 2 drugs? My other option would be to be on neither but just take Ativan as needed for anxiety attacks. If it’s helpful to know, I have been on every single SSRI they make in search of one that doesn’t give me this side effect. The only way I’ve been able to tolerate it is with Wellbutrin or Vyvanse. I’ve also done extensive CBT, meditation, psychotherapy. I am so desperate to do the right thing but I fear never having a child if it means exposing them to the risk of multiple drugs. Thank you for any advice!

[kaytlin]

BookDoctor:

This is a common concern that we hear at the InfantRisk Center. I'm happy to hear you are back on your Prozac, and I can confirm Prozac and Wellbutrin are commonly used together to treat anxiety and depression in pregnancy. There is much more data on the safety of Wellbutrin over Vyvanse.

Anxiety is not usually controlled with one medication, so we frequently interact with moms taking more than one (or even more than 2). Doses are also important in evaluating the impact on a baby, for example, two medications at reasonable doses are often preferred over one medication at a high dose.

Another thing to keep in mind is the value of your mental health. Healthier, happier moms are better equipped to care for babies--when you evaluate the risks and benefits of medications, don't forget to include this in your decision!

Kaytlin Krutsch, PharmD

[BookDoctor]

Thank you so much! I feel tremendous relief having this info as I assess the risk/benefit trade off. I can confirm I take very low doses (am very sensitive fo medication so 10-20 mg Prozac and 150 Wellbutrin.) The same goes for Ativan which can give me relief from an anxiety attack at only .5 mg. I was feeling a lot of anguish because I had read that “mono therapy” is best/safest but in my case, with years and even decades of experimenting it has usually taken 2-3 and I was feeling extremely conflicted over the idea that that would cause increased risk just by virtue of multiple exposures so it’s good to know relatively low doses might be a good thing I have going. Thank you!