Should I continue taking Prozac?

July 17, 2010 5:37 PM

Should I continue taking Prozac?

I was diagnosed with dysthymia after having my first child and was put on 20mg of generic prozac. It really made a difference, I felt better and didn't really have any side effects. Life was pretty good. My anxiety went away and I was happier overall.

That was a couple of years ago and now we want to have another baby. I've cut my dosage in half to 10mg to taper off, but I've noticed a lot of my symptoms are creeping back. I'm irritable most of the time, unmotivated and just want to sit and watch tv and eat all the time. I'm thinking about going back up to 20mg to get back to feeling normal.

Could this be all in my head? A friend of mine said that taking 20mg is pretty much just a placebo dose and wouldn't do anything.

My doctor said that it would probably be fine to take the 20mg and be pregnant and that there are lots of 'prozac babies' running around. She knows about my plans to taper off. And supports whatever decision I make.

I worry about my anger and the effect that it has on my husband and daughter. I'm not mad all the time, but when I am, it's bad. Not abuse-bad, but 'not a good mom' - bad. I'm leaning toward going back up to 20mg, but does that mean I'll be taking it the rest of my life?

Thanks.

posted by anonymous to Health & Fitness (15 answers total)

Could this be all in my head? A friend of mine said that taking 20mg is pretty much just a placebo dose and wouldn't do anything.

Well, depression is almost certainly by definition all-in-your-head, but that doesn't mean it isn't real. And your friend is wrong. 20mg per day is the low end of a typical dosage but it's still within the therapeutic range.

I can't tell you what you should do here. I can tell you that Prozac is generally not considered safe to take while pregnant and that babies are at a substantially higher risk of various problems and birth defects if you take Prozac while pregnant. I have no doubt plenty of people will tell you that they were on Prozac and there were no problems, etc. And they're telling the truth since that's not how probabilities work.

So only you, your husband, and your doctor can know what you should do. But 20mg is not a placebo dose, and Prozac does present some very real risks to a baby.
posted by Justinian at 5:49 PM on July 17, 2010

If your doctor says Prozac isn't known to be dangerous for pregnancy, I would say continue with it. I bet the symptoms of dysthymia are more "harmful". Not eating well, not exercising, not being in the right frame of mind, unable to handle the stress, etc. Even if those things don't directly (biologically) affect the baby, they do effect the family the baby is born into.


Could this be all in my head? A friend of mine said that taking 20mg is pretty much just a placebo dose and wouldn't do anything.

I doubt that's true, but if it is, even better. Doesn't matter how it works if you found a way to treat your symptoms and live a more fulfilling life.
posted by gjc at 5:54 PM on July 17, 2010

does that mean I'll be taking it the rest of my life?

Have you tried other non-drug things to supplement the Prozac? Therapy to help you develop different coping skills or ways of thinking? More exercise or other routines/habits that will help you feel more motivated? I'm not saying to drop the Prozac in favor of those things, but do them before tapering off again.
posted by needs more cowbell at 5:55 PM on July 17, 2010

If your doctor says Prozac isn't known to be dangerous for pregnancy, I would say continue with it.

I doubt that's precisely what the doctor said, because it isn't true.
posted by Justinian at 5:58 PM on July 17, 2010

I would say now isn't the time to worry about whether you'll be on Prozac or some kind of anti-depressant for the rest of your life. Basically, you need to keep asking the question, "Is this helping me now?" and not worry about the idea of having to be on drugs long term because that in and of itself can be depressing. I've had to come to terms with the fact that I can't answer the question of whether I'll be on medicine for the rest of my life, but I do know that I feel good now, and that's my goal.

As for whether you should cut back now, I would say absolutely consult your doctor and OBGYN about this, and consider switching to another medicine (before getting pregnant) if everyone decides drugs need to be continued. Zoloft and Wellbutrin were the two drugs my OBGYN said were generally regarded as safe/safer for pregnancy, but absolutely consult your own doctors and have them assist you and monitor you (and communicate!) with any dosage changes. And then, once you've made a decision, stand by it and don't let anyone tell you what is or is not a placebo affect.
posted by questionsandanchors at 6:17 PM on July 17, 2010 [1 favorite]

You absolutely NEED to be in therapy when tapering SSRIs. I say this as someone who has done it before and is doing it currently. Your neurochemistry should even out eventually, but right now it's like you've been in a cool bath that's suddenly getting warmer- you notice it, and it's scary. I get way more irritable than I ever am on or off drugs. Once things come to an equilibrium, I can't tell you how you'll feel, but I find that it's worse while tapering than it is when you're off altogether. If you ever want to be off of meds completely, unless the dysthymia ends on its own, you need to have the skills to manage it without meds, and you get those skills through therapy.
posted by emilyd22222 at 6:18 PM on July 17, 2010

I do not think this question can be satisfactorily answered in this forum. Justinian is absolutely right about the dosage--20 mg. is a therapeutic dose and only you, your physician(s) and partner can sort this out. The independent research using controlled studies does show elevated risks over controls for different issues during different trimesters. BTW, not all SSRI's have equal risk and some show no evidence of increased risk. Difficult to take into account is that untreated depression, in itself, presents increased risks to not only to the mother but also to the fetus so it is very difficult to sort out. If I were you I would go to a major teaching center that has specific counseling regarding pregnancy and risks. You might find this in Departments of Pharmacy, OB, or Psychiatry. This is an important issue that I would take the time to sit down with an expert and help you sort this out. The studies are confusing and confounding. This is not an issue on which you should make a decision based on "scare" blogs, anecdotes or a physician with a busy practice and limited time to truly sort out the issues
posted by rmhsinc at 6:20 PM on July 17, 2010 [1 favorite]

My shrink says: It could be a placebo, but what if it is? If it works for you, then it works. Same for "all in your head." What's real is how you feel and how you function.

He also says: Don't assume there's anything wrong with continuing to take antidepressants indefinitely. The illness, not the drug, is your enemy -- as long as side effects are manageable. And if one drug turns on you or loses effectiveness, you go to another.

I've been through the same indecision and self-doubt that you have, though I've never been pregnant. It comes around every few years for me and I have to re-decide about the pills I take. I suggest you google "prozac pregnancy" to read doctor's opinions. Prozac does hold risk in pregnancy, and one has to weigh her own situation and mental health in deciding whether to stay with Prozac or any ssri.

Your doubts and fears are probably exaggerated by whatever mood problems accompany your lower dose. See a psychiatrist for one session if you need more background for your decision.

I'm really sorry about your uncertainty and confusion. I know how bad it feels to doubt every option and not to know how to weigh the choices on your own.
posted by wryly at 6:30 PM on July 17, 2010

A good psychopharmacologist would probably be worth a consult. They specialize in tricky meds situations.
posted by fairytale of los angeles at 6:50 PM on July 17, 2010

I used to get effects from less-than-therapeutic doses of psych meds; in general, I am very sensitive to meds, and that was one way it is obvious. My psychiatrist used to gently tease me about it.

There are ways to get through a pregnancy and do what you need to do to stay well. My shrink told me once that one reason some meds stay in the "could be dangerous in pregnancy" category is that nobody can do double-blind studies on pregnant women, so there is a lot of developing judgment about it based on the real-life experiences of people.

I was not on anti-depressants throughout a pregnancy, but I had post-partum depression after my first child was born, and it recurs so predictably that it is part of a standard treatment protocol to start anti-depressants in the third trimester of subsequent pregnancies (I opted not to do that, and was OK--but it was the default option I was presented with). So even if you go off your meds to get pregnant, you probably don't need to stay off them through the entire pregnancy.

Also, a psychiatrist will know which meds are known to be less risky. You may taper off Prozac but take something else that will help with your symptoms while carrying fewer risks for the baby. Your ob probably knows quite a bit about this as well. It is perfectly possible to consult your ob and/or a psychiatrist before getting pregnant; I did before my second pregnancy.
posted by not that girl at 6:55 PM on July 17, 2010

As someone who suffers from chronic depression which is 100% managed by meds, I want to point out that when you're pregnant or considering getting pregnant, it's not just a question of "can I cope without the meds". It is known that suffering from depression during pregnancy can cause premature birth of the baby and/or lower birth weight, among other things (I'm sorry, I don't have any cites in English). At its absolute worst, and I'm sorry to go there, it can lead to suicide, so it's not something you want to mess with.

You're probably in the US I guess, and attitudes are doubtless very different there. However, I would strongly urge you to seek out a psychiatrist or doctor with extensive experience of mental illness and pregnancy. In the Netherlands, where I live, there is a national protocol for dealing with this, so resources are very accessible, but I assume there's nothing similar where you are?

What I'm trying to say is that you need professional guidance in this, and I'm afraid that I personally don't think that "It's your choice" and "It will probably be fine" is good professional guidance. rhmsinc's advice to go to a major teaching hospital in search of an expert sounds like the way to go. I wish you all the best.
posted by rubbish bin night at 4:08 AM on July 18, 2010

How long have you been on the 10 mg dose? If it's less than a week or two, then it would be expected that you would feel some oddness as you make the transition. Tapering the dosage down keeps the process from being mentally crippling. It usually doesn't prevent all symptoms of SSRI-discontinuation syndrome.

Prozac is considered to be one of the mildest SSRIs, and you're coming from the low-end of the dose range. So you wouldn't have to deal with anything like the SSRI- discontinuation-horror-stories that are out there. But there will still be some temporary emotional and mental symptoms. I say give it some time as your brain chemistry re-adjusts.
posted by dodecapus at 7:54 AM on July 18, 2010

I have no opinions about whether Prozac is safe in pregnancy. I discontinued my Prozac halfway through my first pregnancy due to a cohort study that indicated it was worth doing further research to discover if there were really birth problems associated with it. However, when I made the decision to try and get pregnant again, my doctor recommended that I switch from Prozac to Zoloft, because it was safer. I did so, and I found that the zoloft worked really well for me and I didn't have any sort of horror stories. I transitioned from 20mg of Prozac to 50 mg of Zoloft pretty much overnight, and it was a very smooth transition.

(I then found that once I WAS pregnant, the Zoloft made me sick to my stomach, so now I am flying without SSRIs at all. This is a much rougher transition than the Prozac --> Zoloft transition was.)
posted by KathrynT at 9:38 AM on July 18, 2010

I didn't really read through all of the responses to see if someone said this, but you can't really listen to what other people say about their experiences. These meds effect everyone so differently. Also, while it's good to listen to a doctor, they don't know how the meds will effect every person. You say 20 mgs is a 'placebo.' I was on a starting dose of a similar medication that had a huge effect on me, and my doctor initially brushed off my symptoms because the dose was supposedly so low. Any dose of an anti-depressant is serious and should be taken seriously... I just wanted to put that out there.
posted by heatherly at 7:49 AM on July 19, 2010

From a mefite who would prefer to remain anonymous:

I have been treated for depression for years and recently changed medications in anticipation of pregnancy - my doctor recommend I switch from Effexor to Zoloft as it's a safer choice.

I recently became pregnant and talked to my doctor and a specialist about the Zoloft and my concerns w/r/t the pregnancy - I was assured that the best thing was to be sure that *I* as the mother was healthy and that the fetal health was secondary to my own wellbeing. They also assured me that the blood level/dosage is incredibly important when considering whether or not your medication is "safe" and that a lower dosage, when possible, is absolutely better.

Right now I'm on 25 mg Zoloft and while yes, I would absolutely prefer to go off, it's better for my job and my partner that I stay sane during the pregnancy. I've weight the risks to the fetus and decided that I'm comfortable with the known risks of SSRIs - namely developmental delays in the first 3 mos. post-partum.

I don't know what the risks are of Prozac, but I do know that as questionsandanchors said, Zoloft is considered "safer" in terms of anti-depressants and pregnancy risk.

posted by jessamyn at 11:39 AM on July 20, 2010