Fluoxetine

What are the benefits of taking fluoxetine?

Fluoxetine can prevent or reduce the unpleasant symptoms that happen with some mental health conditions. This is important for good quality of life and to ensure that a pregnant woman remains well in preparation for caring for her baby.

Your doctor is the best person to help you decide what is right for you and your baby.

Are there any risks of taking fluoxetine during pregnancy?

SSRIs are commonly taken during pregnancy without any problem. However, some studies have linked SSRIs to a higher chance of preterm delivery, or of having a baby with a low birth weight. It is unclear whether these effects are due to medication, or whether they are due to underlying illness in the mother and other factors.

In the past, SSRI use in early pregnancy was thought to slightly increase the chance of heart problems with the baby. However, more recent studies generally do not support this. Even if there is a small effect, it is clear that most women taking an SSRI will have a baby with a normal heart.

Women taking an SSRI in pregnancy will usually be advised to have a hospital delivery. This is because:

• SSRIs can sometimes cause short-term withdrawal symptoms in the newborn baby. Observation of the baby for a short while after birth may be needed.

• Rarely, SSRI use in pregnancy can cause a problem in the baby, where blood flow to the lungs is too high. This is called persistent pulmonary hypertension of the newborn (PPHN). Around one in every 300 babies whose mother takes an SSRI may develop PPHN. As a precaution, the baby will be checked for breathing problems by a midwife or paediatrician.

• Women taking an SSRI in the month before delivery may have a slightly higher risk of post-partum haemorrhage (abnormal blood loss following birth). A hospital delivery ensures that if this occurs it can be treated quickly.

A large number of studies have assessed the learning and behaviour of children exposed in the womb to SSRIs:

• Some studies have suggested that up to three out of every 100 children born to women taking an SSRI may develop autism spectrum disorder (ASD). In comparison, around one in every 100 children in the background population is diagnosed with ASD. Other studies have found no links between SSRI exposure and ASD.

• Some (but not all) studies have found that children exposed in the womb to SSRIs showed differences in their thinking and learning.

• Some (but not all) studies have suggested that SSRI exposure may affect motor skills (movement), at least in the first few weeks of life.

Although some of this information may seem worrying, more research is required before we can say whether any differences in learning and behaviour are linked to SSRI use in pregnancy, to the mother’s underlying condition, or to a combination of both of these factors.

Untreated depression in pregnancy has been linked to differences in the child’s learning and behaviour. It is important that pregnant women with mental health conditions like depression are treated for their own and their baby’s wellbeing.

Are there any alternatives to taking fluoxetine?

Possibly. Other medicines can be used to treat mental health conditions, but there is no evidence that any of these are safer for the baby than an SSRI. Some people can be treated with talking therapies instead of medicines. However, this does not work for everyone and sometimes a medicine is preferred. If a woman’s condition is well-controlled with fluoxetine, it may be best to stay on it rather than try something new and risk a relapse.

Ideally, women planning a pregnancy should speak to their GP or specialist to decide whether fluoxetine is still the best option for them.

What if I prefer not to take medicines during pregnancy?

It is very important that mental health conditions are treated to ensure a woman’s wellbeing during pregnancy and while looking after her baby. Stopping fluoxetine can increase the risk of relapse and stopping suddenly can cause withdrawal symptoms. A doctor will only prescribe medicines when necessary and will be happy to discuss any concerns.

Women should not stop taking fluoxetine without first speaking to their midwife, GP or specialist.