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Date: Fri, 23 Feb 1996 21:04:17 EST
From: LHSQ76A@prodigy.com (Dr Valerie D Raskin)
Subject: Antidepressants during pregnancy
The literature does not support the notion that fluoxetine in particular causes what most people mean by teratogenesis, gross malformations. A nice prospective study was published in JAMA. The same goes for tricyclics, incidentally.
From: Eduardo Dunayevich <dunayev@penn.com>
Shader discusses use of
fluoxetine in pregnancy in:
Shader RI.
Does continuous use of fluoxetine during the first trimester of pregnancy
present a high risk for malformation or abnormal development to the
exposed fetus?.
Journal of Clinical Psychopharmacology. 12 (6): 441, 1992 Dec.
There is a slightlty higher rate of premature births and
spontaneous abortions, but otherwise it is believed to be reasonably safe for use in
pregnancy.
Date: Wed, 24 Apr 1996 10:08:03 -0400 (EDT)
The JAMA reference on fluoxetine and pregnancy is:
Pastuszak A, Schick-Boschetto B, Zuber C, Feldkamp M, Pinelli M, Sihn
S, Donnenfeld A, McCormack M, Leen-Mitchell M, Woodland C, et al.
Pregnancy outcome following first-trimester exposure to fluoxetine
(Prozac).
JAMA. 269 (17): 2246-8, 1993 May 5.
Comment: JAMA 1993 Nov 10, 270 (18): 2177; discussion: 2178.
This study of 128
women found some increase in miscarriage rate but no increase in birth
defects.
Date: Fri, 23 Feb 1996 19:54:31 -0500
Subject: Fluoxetine during pregnancy
From: Nancy Breslin <breslin@gwis2.circ.gwu.edu>
Subject: Fluoxetine during pregnancy
From: MWKR59A@prodigy.com (Dr Frederick C Goggans)
Date: Thu, 2 May 1996 04:27:14, -0500
Subject: Fluoxetine during pregnancy
A close look at the JAMA article shows that the higher rate of miscarriage in the study was a trend that did not reach statistical significance:
We prospectively collected and followed up 128 pregnant women exposed to a mean daily dose of 25.8 mg (+/- 13 mg) of fluoxetine during the first trimester and compared pregnancy outcome with two matched groups of women exposed during the first trimester of pregnancy to either nonteratogens or tricyclic antidepressants. Rates of major malformations were comparable within the three groups... Women treated with fluoxetine had a tendency for increased risk for miscarriage when compared with women exposed to nonteratogens (relative risk, 1.9; 95% confidence interval, 0.92 to 3.92). The rate of miscarriages in the fluoxetine group was comparable with the tricyclic group (13.5% and 12.2% vs 6.8% in the nonteratogens).
Date: Thu, 5 Sep 1996 04:42:52 -0700
From: "Jim Ellison" <jellison@interserv.com>
Subject: Antidepressants during pregnancy
On Wed, 04 Sep 1996, Eduardo Dunayevich
Date: Fri, 22 Nov 1996 08:19:39 -0800
William Braden wrote:
During breastfeeding: case reports of colic in some infants. Also,
if it causes a problem, there's a long half-life. Consider switching.
However, Chambers CD et al
(from UCSD) reported that ... fluoxetine
seemed to increase the chances of three or more minor malformations (eg,
fused toes)...
Cooper GL: The safety of fluoxetine -- an update. Br J Psychiatry Suppl
1988 Sep; (3): 77-86
Goldstein DJ : Effects of third trimester fluoxetine exposure on the
newborn. J Clin Psychopharmacol 1995 Dec; 15 (6): 417-20
From: Cdbojrab@aol.com (Christopher D. Bojrab, M.D.)
Indianapolis -- (BW HealthWire) -- Jan. 22, 1997 -- The first
study that examines IQ, language and behavior development in children
of mothers who used Prozac (fluoxetine...) during
pregnancy is being viewed by mental health experts as important...
The study, authored by a group led by Gideon Koren, M.D., head
of
clinical pharmacology and toxicology at The Hospital for Sick
Children in Toronto, appears Jan. 23 in The New England Journal of
Medicine.
Dr. Koren's data shows that preschool children of mothers who
took Prozac demonstrated similar neurodevelopmental skills as
children whose mothers used older tricyclic antidepressants (TCAs) or
no antidepressant. The NEJM article is the first published data
regarding the impact on neurobehavior by any selective serotonin
reuptake inhibitor (SSRI)...
"Because half of the pregnancies in North America are
unplanned," Dr. Koren wrote, "many women are eventually using TCA
and fluoxetine during the first few months of their pregnancy.
"Many women who suffer from depression need drug therapy to
secure their well-being during pregnancy," added Dr. Koren, who
heads the Motherisk Program at the hospital and is a professor of
pediatrics, pharmacology and medicine at the University of Toronto...
More published information regarding usage during child-bearing
years is available on Prozac than any other antidepressant. Dr. Koren's study
was funded by the Medical Research Council of Canada.
Date: 07 Apr 97 13:45:05 EDT
I always try
to wean a patient from drugs before a planned pregnancy, slowly! If she gets
pregnant right away, she may go into remission during the pregnancy. Estrogen
has properties in common with psychostimulants and has some antidepressant
effect and may carry her through the pregnancy. She is at increaseed risk
immediately postpartum, though.
If she can't be weaned, I can wait 6 months and
try again -- or she can get pregnant and
stop the drug as soon as she finds out. Again, she
may make it. She can always go back on fluoxetine.
I prefer tricyclics during
pregnancy (because they have been around for over 50 years), at lower doses with
some [residual] symptoms, not aiming for maximal therapeutic effect as we do in a
non-pregnant woman.
You may also have to raise the dose of antidepressant during
pregnancy (especially second and third trimesters) to maintain blood levels or
therapeutic effect. Unfortunately most pregnant women are either overtreated
(too much of the wrong drug) or undertreated (denied medication they need)
during pregnancy.
This topic is indexed under the following subjects:
URL: http://www.dr-bob.org/tips/split/Antidepressants-during-pre.html
The secondary amine TCAs have a fair track record in pregnancy. Also
fluoxetine has been used with a small increase in the risk of spontaneous
abortion or premature delivery.
My understanding is that further pregnancies have now been followed, and that
the original nonsignificant trend toward increased spontaneous abortions is now
regarded as an artifact.
From: Frank Feiner <NFRANK@pol.net>
Subject: Fluoxetine during pregnancy
In pregnancy: more experience with fluoxetine, more documentation
that it is safe (though the others may in fact be just as safe).
I, too, had been under the impression that fluoxetine had been shown to
be "safe" during pregnancy, at least as much as could be demonstrated
without doing (the ethically impossible) randomized clinical trial.
Indeed, there have been several literature reports claiming fluoxetine
had no adverse effects on pregnancy
(Shader RI, Cooper GL, Goldstein DJ),
although there was one reference to increased risk of
miscarriage in humans (Pastuszak A et al).
Date: Fri, 24 Jan 1997 09:28:18 -0500 (EST)
Subject: Fluoxetine during pregnancy
From: Leslie Gise <76106.413@CompuServe.COM>
Subject: Antidepressants during pregnancy
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Dr. Bob is Robert Hsiung, MD,
dr-bob@uchicago.edu
Original tips copyright 1994-97 original authors.
Web page copyright 1995-97 Robert Hsiung.