Joanna is a 24-year-old woman currently prescribed 20mg fluoxetine. Since Joanna’s father passed away ten years ago, she has constant feelings of sadness, hopelessness and loss of interest of her favourite sport. She was subsequently prescribed fluoxetine as treatment.

a) What is the likely indication for fluoxetine and what are the pharmacological actions of fluoxetine? (5 marks)

b) Joanna has recently found out she is pregnant. She is very concerned about the potential side effects of fluoxetine on herself and her unborn child and wishes to stop the fluoxetine immediately. What is your advice in relation to her concerns? (8 marks)

c) What are the options for treatment of her mental health issue? (4 marks)

d) Joanna had a consultation with her psychiatrist and obstetrician and decided to continue treatment. She is planning to breastfeed her child. Her psychiatrist suggested that she may switch her treatment from fluoxetine to sertraline in the future. What is the rationale behind recommending a switch from fluoxetine to sertraline if breastfeeding is desirable? (3 marks)