Can You Take Prozac While Breastfeeding?

If you’re an expectant or new mom, your mental health may have some additional challenges right now. Having a baby isn’t exactly easy on our brains — between the sleep deprivation, feedings, constant learning, and other sources of stress that accompany the actual joys (not sarcasm, we swear!) of being a parent. But the internet is saturated with fears about what happens when you combine a medication like Prozac® and breastfeeding. Is it dangerous?

It’s understandable to be concerned. What you put into your body during pregnancy, after all, can have a huge impact on a fetus and, even after you’ve given birth, you’re still very much sharing your body’s resources with your infant if you’re breastfeeding.

But there’s a second consideration besides the baby to keep in mind: your own mental health. 

The lesser-of-two-evils question about whether to take antidepressants while breastfeeding is still a complicated one, and in times like these, the best thing you can hope to do is make an informed decision — the best decision from what you know, with the guidance of your healthcare provider.

You probably have some big questions about the safety of Prozac while breastfeeding, and the good news is that you’ve come to the right place to get answers. Let’s start with the most pressing question you likely have: is it safe to breastfeed on Prozac?

So let’s jump right into this: is it safe to breastfeed while taking an antidepressant like Prozac? 

With all the talk about the benefits of breastfeeding and human breast milk, it makes sense that breastfed babies are more important than struggling with your mental health in the postpartum period, right?

Unfortunately, the answer to this question isn’t simple and is somewhat incomplete. Currently, there’s no established guidance on a firm “yes or no.” 

Let’s start with what we do know. Prozac, or fluoxetine (the generic version), is an SSRI (selective serotonin reuptake inhibitor) used to treat mental health issues. In addition to its ability to help manage the symptoms of depression, it may also be used to treat generalized anxiety disorder and panic disorders, obsessive-compulsive disorder, bipolar disorder and, occasionally, attention deficit hyperactivity disorder. We know that for the most part, SSRIs have mild side effects when compared with other antidepressants.

We also know that research suggests there may be risks associated with breastfeeding a child while on Prozac. 

That might normally be enough for someone to discontinue or avoid using antidepressants altogether, but where it gets tricky is that there’s no clear understanding right now of whether the risks to a newborn from antidepressants outweigh the symptoms of maternal depression.

Common medical advice is that if you are planning to breastfeed, you should talk to a healthcare provider about your concerns, but that healthcare provider isn’t automatically going to recommend you stop taking medication (or avoid breastfeeding).

Okay, so we’ve acknowledged that there are some risks, and that they should sometimes be avoided. What does that mean exactly, and what’s more important: treating postpartum depression, or the risks associated with exposure to antidepressants?

Depending on your unique circumstances, it may mean totally different things.

Generally speaking, breastfeeding while on Prozac is not recommended. The reason for this is that the medication can be passed to an infant through human milk, which means your infant may ingest some of this medication.

Prozac and fluoxetine have a Category C rating with the FDA. Results can be mixed, which means that some infants may see adverse effects, while others may not have any.  

This can depend on several things, including your dosage of the medication. But, currently, there’s inadequate data to show what effects it can have on an infant in the long term.

It’s certainly an increased risk to a child’s health in the short term, but recommendations can be conflicting on what you should do. 

On the one hand, it’s rarely recommended to discontinue or change a medication that’s working, especially not while pregnant or dealing with the responsibilities of new motherhood. 

But by the same experts, there’s a fairly clear warning that breastfeeding while on specific antidepressant medications like Prozac should be avoided.

That said, studies don’t always show adverse effects for the infant just because they have Prozac in their system.

One case study reported no adverse effects, while another did.

The adverse effects experienced by breastfed infants exposed to the drug in breastmilk were:

• Sleep disturbance

• Crying

• Vomiting

• Watery stools
  

If you’re breastfeeding while on psychiatric medication, you should generally monitor your baby for agitation, weight loss or poor weight gain, reduced growth, irritability, poor feeding and poor sleeping.

It’s possible that your infant could experience some, all, or none of these things — there isn’t clear data on risk levels right now.

And again, the only crystal clear advice we want to offer here is that if you’re currently taking Prozac (or any other antidepressant medication) and are pregnant, intend on becoming pregnant or planning on breastfeeding, you should contact your health provider as soon as possible.

Even if you wish to discontinue your medication to avoid potential risks, you need to talk to a healthcare professional about your decision. Depending on your dosage, they may wean you off of the medication by lowering your dosage over time.

Some sources suggest that other medications with lower excretion levels into breast milk may be preferable. But, again, we have to caution that there’s evidence to suggest it’s never a good idea to abruptly switch from a working medication to another option.

Prozac, like other antidepressants, can have some potential side effects if you suddenly discontinue its use, and while they’re not necessarily life-threatening, they should be monitored by and discussed with a healthcare provider.

Obviously, this puts you in a difficult situation, which brings us back to the question of the lesser of two evils. It’s a tough decision to make, and the most important thing in your decision-making process may be discussing certain individual x-factors about your own unique needs to make the right determination. 

There are mothers who should stop using Prozac; there are mothers who shouldn’t let untreated depression happen. There are probably many in between who will have to make tough choices about using antidepressants during pregnancy and during breastfeeding. Ultimately, it's a decision that should be made with the guidance of your healthcare provider.

While the research is still unclear about Prozac and breastfeeding, the guidance is a little clearer: it’s not recommended and carries a Category C rating from the FDA.

That may sound scary to expectant mothers who are currently taking Prozac, but the most important thing to remember is not to panic. Call your primary healthcare provider and have a conversation with you.

We mentioned that talking to a healthcare professional is important for your health and safety (and that of a fetus) but it’s also important for your peace of mind. 

Decisions about your mental health while pregnant can feel impossibly difficult, and the same goes for the postpartum period — there’s no reason to make those choices alone.

Your primary healthcare provider knows you — including your past medical history, as well as your present needs. They’ll have the answers you seek.

And if you’re not sure where to get started or where to find help, consider our resources. Hers offers online therapy and resources for mental health support that can help you get answers to your questions and guidance on the choices you’re making.

Talk to someone today. This should be a happy and magical time in your life — address these issues so you can get back to enjoying the time you have.