Switching from Prozac to Zoloft during third trimester

[brooklyn]

Hi.

Before becoming pregnant, I was on prozac 60-80 mg for anxiety/depression for about 9 years. I stopped the medication a couple weeks before becoming pregnant, developed OCD/depression and went back on Prozac at approx 24 weeks. I am 32 weeks now and realizing that I want to breastfeed, but I am not necessarily comfortable with the data on prozac and breastfeeding. I have spoken with my psychiatrist about going on zoloft and was informed that I was initially not put on zoloft because I had no history with it and given the acute symptoms I was presenting, they wanted to put me on something they knew would work. I very much want to switch to zoloft before giving birth and my psychiarist is willing to support me. I have two concerns/questions: should I be concerned about exposing the baby to two different SSRIs? When would be the best time to make the switch? Now, right before delivery or after?

Thank you

[cpride]

Dear Brooklyn,

Both Sertraline (Zoloft) and Fluoxetine (Prozac) are suitable for use in pregnancy and lactation. Because you have been on a higher dose of Prozac for the past 9 years and have just re-established symptom relief with this treatment, we do not recommend that you change to Zoloft. Each person can have different success with different SSRIs and because you are having good symptom control we do not see a need to change therapy at this stage in pregnancy. A reduction in dose postpartum may help to reduce infant fluoxetine exposure from breast milk; however, this should only be done slowly and with the approval and monitoring of your psychiatrist.

Although the time it takes to eliminate fluoxetine (half-life) from the body is much longer than sertraline we still think fluoxetine is suitable for use in lactation as long as the infant is monitored for signs of adverse effects. Medication exposure from breast milk is usually much lower than fetal exposure in pregnancy so that is why we do not anticipate any major concerns with breastfeeding.

Because you are on a higher dose and this medication takes longer to eliminate from the body, we recommend that you monitor the baby for any changes in behavior such as irritability, sedation, not waking up to feed, changes in breathing and poor weight gain. Should any of these symptoms occur please report them to your care provider right away. If you or your psychiatrist have any questions, please call our center at (806) 352- 2519,


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