Is it safe to take Prozac (fluoxetine) during pregnancy?

Pregnancy expands your health considerations to include your growing baby. That’s why finding a pregnancy-safe medication to treat depression and anxiety is a top priority for many expectant parents— especially since several drugs, including antidepressants, pose some risk to mother and baby during pregnancy.

But when you consider that 1 in 7 women experience a depressive episode during pregnancy or following childbirth, having access to treatment, including antidepressant medications like Prozac (fluoxetine), is critical.

According to the American College of Obstetricians and Gynecologists (ACOG), depression during pregnancy can have adverse health effects on both the mom-to-be and baby. This includes problems with the growth of the fetus, premature birth, low birth weight, and complications after birth. 

Deciding whether to start or continue taking an antidepressant to treat perinatal depression is something you need to discuss with your healthcare provider. They can help you determine if you should continue taking Prozac while pregnant. Here are the basics you need to know. 

What is Prozac?

Prozac is a brand name for the drug fluoxetine, which belongs to a class of antidepressants called selective serotonin reuptake inhibitors or SSRIs. 

SSRIs work by increasing the amount of serotonin, a normal chemical found in the brain. Providers often prescribe it for depression, panic disorder, obsessive-compulsive disorder, anxiety disorders, and post-traumatic stress disorder. 

Prozac and pregnancy: Is it safe?

Many expectant parents taking Prozac worry about the risk of birth defects. But the good news is despite a slight increased risk of certain birth defects from some SSRIs, including fluoxetine, the actual risk among babies born to women taking one of these antidepressants is still very low, according to a U.S. Centers for Disease Control and Prevention (CDC) study.

A systematic review and meta-analysis found that fluoxetine during pregnancy is associated with a slightly increased risk of cardiovascular malformations in infants. Although the risk is small, Priyanka Priyanka, MD, psychiatrist and medical director at Community Psychiatry, says it’s important to talk with your doctor about the pros and cons of taking Prozac during pregnancy. 

“Untreated depression poses a significant risk during pregnancy, so it’s always worth reviewing risks and benefits of using medications,” Dr. Priyanka says. Overall, research suggests that the benefits of using an antidepressant like Prozac outweighs the risk associated with untreated depression or anxiety during pregnancy.

If you’re taking Prozac, you might be wondering if the drug can make it harder to get pregnant or increase the risk of miscarriage once you are pregnant. More research is required, but one study suggested a mild reduction in fertility when taking antidepressants. 

There’s also minimal information about the risk of miscarriage. That said, one study found that the risk of miscarriage was similar between women exposed to SSRIs during early pregnancy and women who discontinued SSRI treatment before pregnancy. 

Can you suddenly stop taking Prozac when you find out you’re pregnant? 

If you’re considering coming off of Prozac during pregnancy, it’s critical that you do not stop taking it suddenly. It’s also important to discuss this with your provider before making any decision regarding medications. They will be able to advise you on the safest options for your pregnancy. 

The sudden discontinuation of antidepressants during pregnancy is not recommended. “This could potentially lead to worsening mood and anxiety symptoms, which could adversely affect both mom and baby,” explains Leela R. Magavi, MD, psychiatrist and regional medical director at Community Psychiatry. 

Dr. Magavi points to research that indicates that fluoxetine, or Prozac, is one of the safest antidepressants you can take during pregnancy and breastfeeding. If you would rather discontinue medications during pregnancy, Dr. Magavi recommends consulting with a physician who can evaluate your mood state as the dose is gradually decreased over time.

How much Prozac is safe to take during pregnancy?

In general, the recommended dose of Prozac ranges from 10 mg per day for panic disorder to 60 mg per day for bulimia nervosa. The initial dose for depression is 20 mg per day, but your provider may adjust that dosage up or down depending on symptoms. 

According to Dr. Priyanka, the general recommendation is to stay on the dose that provides good control of symptoms of depression. If you take a higher than average dose, Dr. Priyanka says there may be a reason to adjust the dose during pregnancy, but this should be discussed in detail with your provider before making any decisions. 

“If it’s decided that lowering the dose is a relatively safe option, it should be done under close monitoring and possibly may require augmentation with non-pharmacological treatment options like psychotherapy,” she says. 

Is Prozac safe to take while breastfeeding?

Medications that are relatively safe during pregnancy are often safe to take while breastfeeding. Antidepressants like Prozac are generally considered safe to take while breastfeeding; however, research shows that the average amount of the drug in breastmilk is higher with fluoxetine than with most other SSRIs such as sertraline (Zoloft). 

Adverse effects from taking fluoxetine while breastfeeding include an increase in colic, fussiness, and drowsiness. If you have concerns about using Prozac while breastfeeding, make sure to talk to your healthcare provider about the risks and benefits before making any decisions. 

What antidepressants are safe to take during pregnancy and breastfeeding?

The SSRIs Celexa (citalopram), Zoloft (sertraline), and Prozac (fluoxetine) are often the go-to antidepressants to use during pregnancy. 

That said, your doctor may also talk to you about serotonin-norepinephrine reuptake inhibitors (SNRIs) like Cymbalta (duloxetine), Lexapro (escitalopram), and Effexor (venlafaxine). 

RELATED: Is it safe to take Zoloft during pregnancy?

You should always discuss the risks and benefits with your doctor regarding any of these medications while pregnant or during the postpartum period.