Depression is a common mental illness that can affect people of all ages and backgrounds. It’s particularly common in young women — in fact, according to the 2020 National Survey on Drug Use and Health, more than 10 percent of women experience a depressive episode annually.
It’s especially common to develop depression symptoms during or shortly after pregnancy, with up to one in eight women affected by postpartum depression in some states.
If you’ve been diagnosed with depression, your healthcare provider may prescribe Prozac®, an antidepressant medication.
Prozac is a pregnancy category C medication, meaning it should only be taken during pregnancy if the potential benefits outweigh the risks to your fetus. Your healthcare will advise you about what to do if you’re pregnant or nursing and normally take Prozac.
We’ve also discussed Prozac and pregnancy, including the steps that you can take to stay safe if you’re prescribed Prozac and become pregnant.
The FDA first approved Prozac as a treatment for major depressive disorder in the 1980s. It’s also approved as a medication for the following conditions:
Like other SSRIs, Prozac works by increasing the amount of serotonin that’s active in your brain and body.
Serotonin is a natural chemical called a neurotransmitter. It’s involved in regulating your moods, feelings of happiness and levels of anxiety. It also plays a key role in managing your sleep cycle — the natural rhythm that causes you to feel alert during the day and sleepy at night.
Healthy levels of serotonin help to promote emotional stability. On the other hand, low levels of serotonin are associated with several forms of mental illness, including depression, anxiety and obsessive-compulsive disorder.
Because of its effects on serotonin levels, Prozac can help to stabilize your moods and reduce the severity of symptoms of depression, anxiety or OCD.
Prozac is effective for most people, but its effects aren’t immediate. Like other antidepressants, it may take several weeks before you begin to notice changes in your moods, sleep habits and mental well-being after starting treatment with Prozac.
All antidepressants have the potential to cause side effects, and Prozac is no exception. While side effects are less common and typically less severe with Prozac than with older medications for depression, they can still occur.
Common adverse effects of Prozac include:
Asthenia (physical weakness)
Pharyngitis (sore throat)
Prozac may also cause sexual side effects, including a reduced sex drive, anorgasmia (delayed or absent orgasms) and, in men, erectile dysfunction (ED).
Our guide to the side effects of fluoxetine provides more information about these issues, as well as steps that you can take if you develop side effects while using Prozac.
Prozac is a pregnancy category C medication, meaning it should only be used during pregnancy if the potential benefits justify the potential risks to your fetus.
Because SSRIs like Prozac are so widely used, several studies have looked at their risks during pregnancy. In general, research suggests that Prozac might be associated with a slight increase in the risk of birth defects, including cardiovascular malformations (heart defects).
In one large-scale observational study published in the British Journal of Clinical Pharmacology in 2008, researchers looked at the potential risks of the medications fluoxetine (the generic form of Prozac) and paroxetine (Paxil®) in pregnant women.
The researchers compared the cardiovascular health of children born while mothers were using fluoxetine and paroxetine to more than 1,460 controls (children born to mothers who did not use SSRIs during pregnancy).
The study found a possible association between exposure to fluoxetine during the first term and certain cardiac defects in children.
A more recent systematic review and meta-analysis from 2017, which was also published in the British Journal of Clinical Pharmacology, also found that the use of fluoxetine during pregnancy was associated with a slightly increased risk of cardiovascular defects in infants.
Although these findings sound alarming, it’s important to keep in mind that the absolute increase in the chance of birth defects is small.
Put simply, although there is an increased risk of cardiovascular malformation in infants exposed to Prozac in pregnancy, the overwhelming majority of babies born to women who use SSRIs like Prozac are born healthy and without any significant issues.
If you’re planning to become pregnant in the future, you may have concerns about the effects of Prozac on your fertility.
Although scientific research is limited, one study published in the American Journal of Obstetrics and Gynecology found that use of antidepressants is associated with a mild decline in the ability of women to conceive naturally.
However, it isn’t completely clear if this link is caused by antidepressant use itself or the effects of depression on sex drive and fertility.
If you’re pregnant or planning to become pregnant in the near future and currently use Prozac to treat major depressive disorder, panic disorder or any other condition, it’s important to reach out to your healthcare provider for professional advice.
Your healthcare provider will make an informed decision about the safety of using Prozac during pregnancy based on your needs and the needs of your infant.
Although Prozac is associated with a slightly increased risk of cardiac malformations, untreated depression during pregnancy may also contribute to a higher risk of negative outcomes for you and your child.
Risks associated with untreated depression during pregnancy include:
Infant growth difficulties
Lower-than-normal birth weight
Increased risk of spontaneous abortion
Low Apgar scores (a measure of infant health)
Many of these issues can have a serious impact on the health and well-being of your child. Being depressed while pregnant can also have negative effects on your mental and physical health as an individual.
Common symptoms of depression include:
A persistent sad, anxious, empty or helpless mood
Reduced interest in your normal hobbies and activities
Feelings of pessimism, hopelessness, guilt and worthlessness
Difficulty focusing, remembering things or making decisions
Irritability, feelings of restlessness and difficulty relaxing
Changes in your appetite, eating habits and weight
Cramps, aches, pains and/or digestive problems
Difficulty falling asleep or staying asleep
Thoughts involving death or suicide
When severe or persistent, these symptoms may affect your ability to care for yourself and stay healthy during pregnancy.
Your healthcare provider will assess these risks and weigh them against the risks of issues from Prozac during pregnancy, then make an informed decision about your medication to ensure you and your baby stay safe and healthy.
If you’ve recently found out that you’re pregnant, it’s important not to stop taking Prozac without first talking to your healthcare provider.
Stopping Prozac suddenly can cause your major depression symptoms to become more severe, which may affect your well-being. It can also contribute to the development of sudden withdrawal symptoms, referred to as antidepressant discontinuation syndrome.
Symptoms of antidepressant withdrawal include:
Numbness/tingling in hands and feet
If your healthcare provider instructs you to stop taking Prozac while pregnant, they’ll provide you with detailed information about tapering your dosage.
Gradually tapering your dosage of Prozac can help to reduce your risk of developing withdrawal symptoms. You may need to slowly reduce your dosage of Prozac over several weeks to reduce your risk of experiencing side effects or other negative symptoms.
If you’re prescribed Prozac and become pregnant or plan to become pregnant in the future, it’s important to talk to your healthcare provider before making any changes.
Prozac is associated with a slight increase in birth defect risk, including certain congenital heart defects. However, failing to treat depression while pregnant can also create real safety risks for you and your child.
Your healthcare provider will consider all of these factors and suggest the safest, most effective option for you and your child.
Make sure to closely follow your healthcare provider’s instructions and inform them if you notice any side effects from Prozac while pregnant or breastfeeding.
Worried you may be depressed? We offer fluoxetine (the active ingredient in Prozac) and other depression and anxiety medications online, following a consultation with a licensed psychiatry provider who will determine if a prescription is appropriate.
Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.
Start your mental wellness journey today.