Brief Answer:
Psychotherapy can help

Detailed Answer:
Hello,

Thanks for writing to us.

I can understand your situation.

We should avoid any medicine during pregnancy as far as possible.

As you were stable on fluoxetine since 8 years, ideally we should not atop that.But yes considering pregnancy we must try without it.

In your case following approaches are there.

Psychotherapy can help in such anger management and depression.

Specifically Psychodynamic therapy for anger and cognitive behavior therapy(CBT) for depression are useful. You can discuss with your psychologist about the same. Short term psycho dynamic therapy is better option at this stage.

If you do not feel any improvement within 6 weeks of psychotherapeutic approach, other option is ECT.

Electro Convulsive Therapy is even indicated in pregnancy and post partum lactating mothers.If you improved with ECT , so called maintenance ECT can be given during pregnancy also if needed.

If ECT will not help or you deny to take it , last resort is to start fluoxetine again considering risk benefit ratio. Stop fluoxetine as soon as you become aware that you are pregnant. After that you should take care for 3 months without medications. And from 4th month of pregnancy Escitalopram(Lexapro) can be started. It is SSRI like fluoxetine but the safest SSRI during pregnancy and with the least fetal complication(0.5 to 3% incidence). Even you can be given escitalopram at this stage also before pregnancy instead of fluoxetine.

No natural remedies except psychotherapy is there to treat your problem.

You should take care of your meal timing, sleep timing and exercise which can help to prevent worsening of symptoms.

Discuss above aspects in detail with treating doctor and move forward.

Hope I have answered your query, I will be happy to help further.

Regards,
Dr.Chintan Solanki.

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Brief Answer:
Prozac and zoloft are also relatively safe

Detailed Answer:
Hello,

Thanks for follow up. Sorry for delayed response.

Yes prozac and zoloft are safe(not the safest). Actually all SSRI including Prozac, Zoloft and Lexapro are pregnancy category drug C.

I have attended one CME before 6 months on this topic. In that lecturer has shown many latest studies suggesting lexapro (escitalopram) should be first choice if anti depressant is needed during pregnancy.So I am talking about recent updates. Previously I used to prescribe zoloft but after that CME I have started lexapro in such cases.

You are absolutely right that ECT is indicated in severe depression. But it does not mean that it should be used only in severe depression. Pregnancy is the state in which many women deny to take risk of medicine related side effects and we provide such options.

Check following links just for your reference about safety of ECT during pregnancy.

http://womensmentalhealth.org/posts/ect-and-pregnancy/

http://www.ncbi.nlm.nih.gov/pubmed/0000

Hope this answers your query. Feel free to discuss further.

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