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| Antidepressant;Prozac(Fluoxetine) |
In today's article we're going to be talking about fluoxetine or Prozac and this is in response to one of our reader who asked us to write an article about this medication. If you would like us to write an article specifically for you go ahead and drop the idea in the comment section below as our goal is to help impact you and your mental health care journey so without further ado here we go: First Thing: What is Fluoxetine?
Fluoxetine was the first second generation antidepressant that came out in the United States in 1987 and it revolutionized the antidepressant market as the first generation antidepressants. The tricyclics and the MOAs were not very well tolerated as the side effects were awful and they increased risk of death when taking an overdose. So many providers stayed away from prescribing treatments for depression but when fluoxetine came out and was found to be a lot safer than the first generation anti-depressants.
It created this shift in the treatment of depression where now many providers were comfortable prescribing fluoxetine for patients to help them with their depressive symptoms including primary care providers so you could just go to your family care provider and get a prescription for fluoxetine. This pattern created a culture shift in the 90s and with target marketing change the view of the American dream to be able to obtain happiness in a pill.
So moving on Fluoxetine is an SSRI or Selective Serotonin Reuptake Inhibitor very similar to sertraline, and it has actions on many serotonin receptors however its antagonist reaction on the serotonin receptor 5HT2C has stimulating or activating effects.
Due to the fact that it can increase norepinephrine and dopamine and in higher dosages so greater than 60 milligrams it's actually a weak norepinephrine reuptake inhibitor increasing its activating properties. Also Fluoxetine and other SSRIs are shown to be anti-inflammatory which is very important in the treatment of depression because inflammation has been shown to be a cause of depression.
Second Thing: What Its Used For?
Fluoxetine is FDA approved to treat the symptoms of Major Depressive Disorder. It is specifically very useful for targeting those symptoms of lethargy or being very fatigued and tired having what's called a blunted affect. Not being able to be motivated or getting out of bed fluoxetine is very beneficial due to those activating properties.
However it's also FDA approved for the treatment of obsessive-compulsive disorder disorder, Bulimia, Premenstrual dysphoric disorder and when combined with Olanzapine and Atypical Antipsychotic it's actually approved for the treatment of bipolar depression and treatment resistant depression.
It also has some off-label uses such as social anxiety disorder PTSD, binge eating disorder and more recently due to those anti-inflammatory properties it's actually being used to help reduce the symptom severity of COVID-19.
Third Thing: How Long Does it take to work?
Well just like other antidepressants this isn't a miracle drug and it doesn't start working right away but fluoxetine tends to work a little more quickly than the other antidepressants. As generally speaking it'll take about two to four weeks before you start to see improvement in your symptoms.
However some patients need four to six weeks before they start seeing symptom improvement. Now if you're on a therapeutic dose which is anywhere from like 20 to 60 milligrams and you're still not having any improvement after eight weeks of being on this medication. Then you need to have some change in your regimen or augmentation of your treatment which could be maximizing the dose to 80 milligrams.
Changing the medication altogether or adding another medication to help boost the effects of fluoxetine. However this should all be done under the direction of your mental health care provider. Once your symptoms have been remitted or once your symptoms have resolved it's advised that you stay on fluoxetine for at least six months .
Fourth Thing: Is Fluoxetine Addicting?
The fourth thing that you should know about fluoxetine which is, Can it be addicting? or is this medication addicting if I'm gonna be on it for six months or longer can I just come off of this medication? Well the answer is none of the antidepressants are addicting none of the antidepressants cause you to crave the medication to seek for higher dosages of the medication. Or in any case want more and more and more until you can't get enough.
Antidepressants simply does not cause addiction however your body does get used to that increased level and so just abruptly stopping an antidepressant can cause like a serotonin abstinence syndrome. However with Fluoxetine this rarely happens and that is because Fluoxetine is very unique in the fact that it has a long half-life.
It means it stays in your system for a very long time it can stay in your system for weeks and in doing so it actually self tapers or tapers itself out of your system. So most people will not have an abstinence syndrome or a withdrawal effect from fluoxetine.
Well I say most because there are some patients who will still experience some of these withdrawal effects so that's why you should never abruptly stop taking any medication and discuss it with your provider so that it can be done safely.
Fifth Thing: Side effects of Prozac(Fluoxetine) and Drug Interactions
The fifth and final thing that you need to know about Fluoxetine which is the side effects and drug interactions now because Fluoxetine stays in your system for so long you have to be very careful. Specially about drug interactions specifically if you're switching from fluoxetine to another antidepressant your mental health care provider will do so very cautiously.
The procedure of switching will be that your provider probably start you on another antidepressant at a very low dose and then titrate or increase that dose to a therapeutic dose. But do it more slowly because that fluoxetine will still be in your system also you shouldn't switch from fluoxetine to the MOAIs or that first generation antidepressant because it can actually cause serotonin syndrome .So it's advised that you stop fluoxetine for at least five weeks before switching to one of those types of medications
Drug Interactions of Prozac
Now when it comes to drug interactions fluoxetine does have a lot of drug interactions which is why many providers will hesitate to prescribe it if you're taking a lot of medications. These drug interactions are the result of fluoxetine being an inhibitor of two different metabolic substrates which a lot of medications get metabolized by.
So being an inhibitor of these substrates it actually causes toxic levels or high levels of these medications in your system. This list of medications is just an example of a lot of the medications that fluoxetine can have interactions with but it's not comprehensive by any means.
Because there are many other medications that are metabolized by those enzymes and so therefore it is important once again to talk to your mental health care provider to discuss possible drug interactions.
Prozac Side effects
So now you're probably wondering like everybody else are there any side effects well of course there are side effects there are side effects to any medication including Tylenol so Fluoxetine is no different. Because of those stimulating properties or those activating properties of fluoxetine the most common side effects will be,
- insomnia
- anxiety
- agitation
- dry mouth
- headache
- dizziness
- increased sweating
- decrease in appetite
- nausea
- a little discomfort in the stomach
- some diarrhea
- unfortunately decreased libido
- decreased sexual arousal may occur
But just keep in mind that when you have major depressive disorder this can also be a symptom of depression and if you're experiencing this symptom then talk about it with your provider. Because there are things you can do to help lessen the impact of this potential side effect.
And also keep in mind that a lot of these side effects will pass after taking the medication. For about a week as your body adjusts to it now there are many other rare and dangerous side effects to this medication and other anti-depressants.
Conclusions
So there you have it those are the top five things you need to know about fluoxetine is there anything else that you would like to add to that list go ahead and put it in the comment section below .Are there other medications that you would like us to cover or talk about put that in the comment section below as well. Because again we want to help you on your mental health care journey I thank you for watching and I'll look forward to seeing you next week.
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