A Question Of Health

What's causing my hiccups? Can I take Prozac while pregnant?
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Q. I have become prone to hiccups. I can get several attacks a day, each lasting up to five minutes. They can come on in the middle of a meal, or after eating, or for no reason at all. I can usually stop them by drinking very cold water, or sucking on an ice cube. I feel the problem is linked in some way to my digestive system, but I don't know how to cure it.

A. A hiccup is caused by a sudden, involuntary contraction of the diaphragm, causing a rapid inspiration of air. The "hic" sound occurs when the inspiration is blocked by the closure of the vocal cords. Hiccups are not abnormal, and nearly everyone has experienced them at some time. Babies even hiccup before birth, in the womb.

If a bout lasts for a minute or two and then goes away, it has usually been caused by some irritation to the diaphragm, often related to eating too fast or swallowing some air. Occasionally, hiccups become persistent, or intractable. Persistent hiccups are defined as hiccups that last for more than 48 hours. Intractable hiccups last for more than a month. These are rare, and are often caused by some underlying disease. The most likely problem is disease of the oesophagus or stomach. Gastric reflux, which lets acid out of the top end of the stomach into the oesophagus, is probably the most common cause of long-lasting hiccups. Occasionally, someone with persistent or intractable hiccups ends up in hospital, where they may be found to have a tumour irritating the diaphragm, or even a tumour in the lower part of the brain (the brain stem).

If your hiccups remain a minor irritation, there is no need to do anything about them. If they get persistently worse, or if they won't go away, you need to have some tests to see if anything is upsetting your diaphragm.


Q. Is it safe to take Prozac during pregnancy? I've taken it for several years and it has made a huge difference to my depression - when I take it I am well, when I stop it I get irritable and depressed. I want to get pregnant, and I worry that if I have to stop the Prozac I will find it difficult to cope with the pregnancy.

A. Prozac (chemical name fluoxetine) was first marketed in the United States in 1988. It has been taken by many thousands of pregnant women. All doctors will tell you that it is better not to take any drugs during pregnancy, but the evidence is that Prozac is remarkably safe. There is no evidence at all that it causes birth defects or malformations. There have been concerns that it may affect a baby's growth and development after birth, but many studies have failed to show any substantial adverse effects. And remember: untreated depression during and after pregnancy can adversely affect babies. Talk to your doctors about the risks and benefits of continuing with Prozac during pregnancy. For someone who suffers from disabling depression, the decision will probably be that the benefits outweigh the risks.

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Send your questions and suggestions to A Question of Health, 'The Independent' 191 Marsh Wall, London E14 9RS; fax 020 - 7005 21 82; or e-mail health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally to questions