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What
is Prozac?
Prozac (fluoxetine) is an antidepressant medication originally
approved by the FDA in 1987 and currently available for the
treatment of depression, obsessive-compulsive disorder, and
bulimia nervosa. Prozac has also been used off-label (which
means a use not reviewed by the FDA) to treat panic disorder.
Under a different brand name (Sarafem), fluoxetine is also
approved for the treatment of premenstrual dysphoric disorder
(PMDD). Prozac is believed to work by blocking the reabsorption
of serotonin, a neurotransmitter or chemical messenger in
the brain. It is a member of the serotonin-reuptake inhibitor
(SSRI) family, as are Zoloft (sertraline) and Paxil (paroxetine).
How
is Prozac different from other antidepressants?
Prozac is overall as effective in relieving depression as
older tricyclic antidepressants (TCAs) such as imipramine.
However, not all antidepressants are equally effective for
a specific individual. Prozac causes fewer adverse heart-related
events (such as a drop in blood pressure or unusual rhythm)
and fewer anticholinergic effects (dry mouth, constipation,
blurred vision, urinary retention) than TCAs. And it is less
likely to cause drowsiness or weight changes also associated
with the older TCAs. A special diet is not necessary when
taking Prozac, which may be the case with other antidepressants
known as monamine oxidase inhibitors (MAOIs). The incidences
of death resulting from an overdose of Prozac have been extremely
rare, which may help doctors feel more comfortable prescribing
it.
What
are the side effects of Prozac?
The most common side effects seen in people taking Prozac
include anxiety or nervousness, insomnia, drowsiness, headache,
diarrhea, and rash. In addition, sexual side effects (reduced
arousal or satisfaction) may occur. Prozac has also been shown
to cause changes in appetite and weight, usually resulting
in weight loss rather than weight gain. Most side effects
are mild and brief, usually subsiding in a week or two after
beginning treatment, but sexual side effects often persist.
Particularly bothersome side effects can be treated with medication
or by reducing the dose of the antidepressant, changing the
time the medication is taken, or switching to a different
antidepressant.
Is
there a significant risk of suicide for people taking Prozac?
Suicide is always a risk in people with severe depression,
and it may persist until significant remission occurs. However,
consumers and their families must be cautious during the early
stages of treatment with all antidepressants, when energy
and activity may return before mood improves. At this time
- when depression is still severe but when a depressed person
may have more energy to take action - the risk of suicide
can temporarily increase.
How
does Prozac interact with other medications?
Prozac should not be taken until at least two weeks after
MAOIs (e.g., Nardil and Parnate) are discontinued. Similarly,
MAOIs should not be taken for at least five weeks after treatment
with Prozac has been discontinued. The interaction between
the two could produce fatal results. Consumers should always
consult with their physicians when taking medications in addition
to the prescribed antidepressant.
What
is the standard dose of Prozac?
Prozac is used to treat depression, obsessive-compulsive disorder,
and bulimia nervosa. For the treatment of depression and obsessive-compulsive
disorder, a dose of 20 mg/day, taken in the morning, is recommended
as the initial dose. A dose increase may be considered after
several weeks if insufficient clinical improvement occurs.
The maximum Prozac dose should not exceed 80 mg/day. For the
treatment of bulimia nervosa, the recommended dose is 60 mg/day,
taken in the morning. Prozac doses above 60 mg/day have not
been systematically studied in people with bulimia.
How
long should I take Prozac?
While there are no studies that answer the question of how
long to continue Prozac, depression, obsessive-compulsive
disorder, and bulimia nervosa are usually chronic conditions,
and it is reasonable to consider longer term treatment for
a consumer who is responding well. After 6 months, particularly
for depression, it is reasonable to consider trying to reduce
the dose to see whether symptoms return. As with other medications,
discontinuing Prozac should be discussed with your doctor
and a plan for discontinuation should be developed rather
than simply stopping on your own. In clinical trials, Prozac’s
antidepressant efficacy has been maintained for periods of
up to 38 weeks, following 12 weeks of acute treatment. For
OCD and bulimia nervosa the efficacy of Prozac beyond 16 weeks
has not been documented in controlled trials. However, people
have continued in therapy for many years without loss of benefit.
Dose adjustments maintain the consumer on the lowest effective
dosage, and consumers should be periodically reassessed to
determine the need for continued treatment.
How
soon after starting treatment will I feel better?
Someone starting treatment with Prozac may notice some improvement,
particularly in concentration and increased energy, within
one week. As with other antidepressants, it usually takes
three to six weeks for the full therapeutic effect of the
drug to be felt. The medication should be taken at the prescribed
dose for six full weeks before evaluating its effectiveness.
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and supports, and medications;
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