To : Jennifer
Re : Prozac

First, while I think the literature supports the use of Zoloft over Prozac, it is
quite well known that some
patients simply don't respond to some SSRIs (serotonin reuptake inhibitors) like
they do others.  So often physicians have to switch between
these drugs to find one that the patient  likes and does best on.

While I am uncomfortable with the use of Prozac in the neonatal period,  a 10
month old infant should do just fine
with exposure to Prozac.  I would suggest the lowest possible dose, say 20 mg,
but even 40 is probably alright with this infant.

As for the Ritalin,  I've never heard of adding this to an 'activating' SSRI
before, but I would defer to this psychiatrist's experience on this subject..   I
suppose that if the mom did not breastfeed the infant for 5-8 hours after taking
the med, then the infants exposure would be lessened.  However, I would still
observe this infant closely for hyperactivity, insomnia, and anorexia.  At the
first sign of any of these, then I would question the use of Ritalin.

I do have another suggestion.  The SSRI  Effexor, acts much like the other ones,
but also has an 'activating component' that stimulates
norepinephrine and serotonin, both.  This would mimic the Ritalin effect to some
degree.  We have one paper on Effexor, and the milk levels were moderate to
low, with no effect on the breastfed infants.  Perhaps the patients' doctor might
try Effexor instead of the Prozac+ Ritalin mixture to see if
it would help this mom.

Regars

Tom Hale, PH.D.
Associate Professor of Pediatrics

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