Antidepressants Selective serotonin reuptake inhibitor (SSRI)
Prozac / Fluoxetine
What’s the deal with Prozac? - a hella controversial drug
Probably the most talked-about, yet the least known-about drug I’ve ever heard. Thank you media for making this drug particularly stigmatized, even more than other psychiatric drugs.
Prozac is used in treating various forms of depression, often in conjunction with psychotherapy. Prozac is also used in treatment for obsessive compulsive personality disorder (OCD) and in patients with Bulimia nervosa. Interesting unlabeled uses include: treatment of anorexia nervosa, attention-deficit hyperactivity disorder, diabetic neuropathy, fibromyalgia, obesity, panic attacks, premenstrual syndrome, and Raynaud’s phenomena
Prozac works by selectively inhibiting the reuptake of the neurotransmitter serotonin in the central nervous system (CNS) neurons, and increases the amount of serotonin that’s available in nerve synapses. An elevated serotonin level may result in elevated mood, and, consequently, reduced depression.
Serotonin
Serotonin is known as a biogenic amine; it has shown to be a mood regulator. Interestingly, the relationship between depression and this hormone was linked during treatment for hypertension. Patients were being treated with a biogenic amine-depleting agent reserpine, and they became depressed. Patients who were being treated for tuberculosis with ipronazid, a biogenic enhancing agent became euphoric.
Serotonin generally serves inhibitory functions in the brain, and disturbances in its functioning may underlie the irritability, anxiety, and sleep disturbances common in depression.
Contraindications
*Use of MAO inhibitors in combination with SSRI’s can cause serotonin syndrome due to abnormally high levels of serotonin in the body. The signs and symptoms of this include: diarrhea, fever, hyperactive reflexes, increased sweating, mood changes, rapid heart rate, restlessness, and shivering or shaking
Refer to pharmacology reference for extensive list of drug interaction
Side Effects
CNS: Anxiety, chills, nightmares, fatigue, fever, headache, hypomania, insomnia, mania, nervousness, restlessness, seizures, tremor, yawning
Cardiovascular (CV): Hypotension, palpitations
Eyes, ears, nose, throat (EENT): Abnormal vision, dry mouth, pharyngitis, sinusitis
Endocrine (ENDO):Galactorrhea, gynecomastia, hypoglycemia
Gastrointestinal (GI): Anorexia, diarrhea, indigestion, nausea
Genitourinary (GU): Decreased libido, ejaculation disorders, impotence
Heme: Altered platelet function
Musculoskeletal (MS): Arthraliga, myaligia
Resp: Dyspnea
Skin: Diaphoresis, pruritus, rash, urticaria
Route and Dosage
Prozac is taken by mouth (PO). In treatment with depression and OCD the normal dose is 20mg/day in the morning. After several weeks the dose may be increased by 20mg/day at weekly intervals. Doses given greater than 20mg should be divided doses; not to exceed 80mg/day
Treatment for Bulimia nervosa is normally 60mg/day
Caution
Do not take this drug within 14 days of taking MAO inhibitor antidepressants.
Do not double dose if missed dose and do not discontinue medication without consulting a health care provider.
Avoid taking alcohol or other CNS depressant drugs during therapy and consult a health care professional prior to taking any other medications, including over-the-counter meds.
Female patients should consult their physician if pregnancy is planned or expected
Comments on side effects: I’ve read a lot of material written by patients who have taken this medication and didn’t do well with it in terms of evading the listed side-effects. In truth, I’ve never used Prozac so I have no personal perspectives on these side-effects or on the side-effects of any other psychiatric medications. Considering whether or not you are going to use Prozac is a decision that should be made as an informed person. It is important to recognize that the side-effects of Prozac may be less than the detrimental effects of mental illness. It is a decision that the patient must make and that decision should be respected by health care professionals. If you are finding that your wishes are not being respected, it may be advisable to consider seeking help from a different physician.