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Prozac: What is it? Uses, Side Effects, and Dosage

Depression is an epidemic in the United States, with an estimated 17.3 million American adults, or 7.1 percent of the population, experiencing a major depressive episode in 2017. For people who are suffering from serious depression, medications like Prozac may offer hope for symptom relief. Prozac is one of the most recognizable pharmaceutical medications on the market today as a result of its popularity and widespread use.

What is Prozac?

Prozac, known under its generic name of fluoxetine, was the first medication introduced in the class of antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs), which are commonly used to treat depression and anxiety today. Prozac was first introduced to the market in 1986, and it has since become one of the first drugs that people think of when they think of antidepressant medications.  Nearly 22 million prescriptions were written for Prozac in 2017, making it the most well known and one of the most popular SSRIs on the market.

What is Prozac Used to Treat?

Prozac was first approved to treat clinical depression in 1986, but since then, it has been approved for the treatment of many other mental health conditions, including major depressive disorder (MDD), obsessive compulsive disorder (OCD), panic disorder, bulimia nervosa, and premenstrual dysphoric disorder (PMDD). A brief explanation of each of these conditions and their associated symptoms is provided below.

Clinical Depression/Major Depressive Disorder
Clinical depression, also known as major depressive disorder, is characterized by persistent and intense feelings of sadness that last for extended periods of time. Not only can depression impact your mood and behavior, it can also have physical characteristics as well, including appetite and sleep. People who experience major depression may lose interest in doing activities that they once enjoyed or have trouble performing everyday activities, and they may have suicidal thoughts and tendencies. Approximately seven percent of American adults has an episode of clinical depression each year, making it one of the most common mental illness issues in the U.S. Symptoms of major depressive disorder include:

  • Feeling sad, empty, or tearful
  • Feelings of worthlessness, guilt, hopelessness, or helplessness
  • Lost of interest in activities you used to enjoy
  • Difficult concentrating and low energy
  • Sleeping and eating more or less than usual
  • Nervous energy
  • Feelings of moving or thinking in slow motion
  • Suicidal thoughts or behaviors

Obsessive Compulsive Disorder
Obsessive compulsive disorder, also known as OCD, is characterized by obsessive, worrisome thoughts that cause anxiety, such as the loss of a loved one, combined with compulsions, or behaviors that are performed to relive the anxious thoughts. People with OCD feel compelled to perform certain rituals repeatedly, such as locking and unlocking the door, even when they do not want to or when it is inconvenient. Obsessive compulsive disorder typically develops in childhood or early adulthood and intensifies later in life. Symptoms include:

  • Anxiety about germs and dirt
  • Fear of contamination
  • Need for symmetry and order, including obsessive cleanliness
  • Feeling that you can protect other people by performing certain behaviors or rituals
  • Difficulty throwing away things of little to no value (hoarding tendencies)
  • Disturbing thoughts 
  • People with obsessive compulsive disorder may exhibit some of the following behaviors:
  • Excessive hand washing, showering, or repetitive cleaning
  • Checking things over and over again, such as making sure the door is locked
  • Hoarding unnecessary possessions of little value
  • Rearranging things continuously to get them “just right”

Panic Disorder
Panic disorder is a type of anxiety disorder characterized by unexpected and repeated episodes of intense fear that cause physical symptoms. Physical symptoms associated with panic disorder are often called panic attacks and include chest pain, shortness of breath, heart palpitations, sweating, dizziness, and nausea.

Bulimia Nervosa
Bulimia nervosa is a type of eating disorder characterized by a binging on food (eating an unusually large quantity of food, typically in a very short amount of time, past the point of fullness) and then using certain methods to purge the food in order to prevent weight gain. People with bulimia nervosa may abuse laxatives, induce vomiting, or exercise excessively to prevent weight gain.

Premenstrual Dysphoric Disorder
Premenstrual dysphoric disorder (PMDD) is characterized by heightened experiences of depression, tension, and irritability for several days prior to menstruation. Although some of these symptoms are common in women prior to their periods, PMDD is characterized by extreme manifestations of these symptoms. 

How Does Prozac Work?

Prozac belongs to a family of drugs called selective serotonin reuptake inhibitors (SSRIs), which work by blocking the absorption of serotonin, a neurotransmitter, in the brain. SSRIs help regulate the amount of serotonin in the brain, which helps brain cells transmit messages to each other, resulting in an improved and more stable mood. Prozac also activates neurons in the hippocampus, which is a portion of the brain that is responsible for forming memories. People who experience depression and take Prozac may experience an improved mood, regain interest in old hobbies that they once enjoyed, and feel the physical symptoms of depression ease. The mood stabilizing effects of Prozac also help people with the other conditions treated by Prozac.

What is the Cost of Prozac?

Like most medications, the brand name form of Prozac is substantially more expensive than the generic form of the drug, fluoxetine. The generic form of the medication is typically covered by most Medicare and insurance plans, but it may be possible to receive a cheaper price on the drug by using a pharmacy discount card or coupon or paying the cash price. The following table compares the costs of a 30 day supply of Prozac and fluoxetine. You can get this medication over-the-counter. 

Costs of a 30-Day Supply of Prozac and Fluoxetine

 

 

Prozac

Fluoxetine

10 mg oral capsules

$477.43

$4.00

20 mg oral capsules

$490.75

$4.00

40 mg oral capsules

$973.10

$4.00


Because there are many different manufacturers for fluoxetine, the prices of the drug are extremely affordable even for those who are uninsured or underinsured. People who are concerned about taking the generic form of a medication should know that the U.S. Food and Drug Administration (FDA) subjects generic forms of the medication to the same stringent testing as the brand name form of the drug. The generic medication uses the same active ingredient as the brand name form of the medication in the same amount, but may use different inactive ingredients that affect the color, size, shape, or taste of the medication. However, you will receive the same treatment when using a generic medication of the same form and strength as you would with a brand name medication.

What are the Benefits of Using Prozac?

Although many new SSRIs have been introduced since Prozac first hit the market in 1986, the medication remains an extremely popular choice for the treatment of mental health issues due to the many benefits offered by the drug. Benefits associated with the use of Prozac include:

  • Prozac is more energizing than other antidepressant drugs, so it may help you feel more energetic if you have naturally low energy levels or if you are experiencing low energy due to depression.
  • Prozac has been proven to be effective at treating a number of different mental health conditions, including major depressive disorder, obsessive compulsive disorder, panic disorder, bulimia nervosa, and premenstrual dysphoric disorder, so individuals suffering from several of these conditions may find relief with one medication.
  • Prozac does not carry the risk of adverse effects associated with the heart, making it more likely to be well tolerated by older adults.
  • Increased energy levels caused by Prozac can contribute to weight loss, which can help people who are overweight.
  • Prozac is able to treat children with major depressive disorder or obsessive compulsive disorder.

How Do I Know What Dose of Prozac to Take?

Your doctor will determine the appropriate dose of Prozac for you based on your age and the purpose of treatment, but your medication dose may have to be adjusted several times before you get it just right. The standard treatment for adults suffering from major depressive disorder starts at 20 mg per day, taken in the morning. Doctors may increase your dose by 20 mg every few weeks as needed, but the standard dose is between 20 and 60 mg per day. The maximum recommended dose of Prozac is 80 mg per day. Prozac is also available in a delayed release oral capsule that is taken weekly. When taking the delayed release oral capsule, patients will take a 90 mg capsule once per week. The effects of Prozac are normally experienced in about four weeks.

Patients who take Prozac should not abruptly stop or change their dose without consulting with their doctor, as this can cause withdrawal symptoms if a patient has been using the medication for six weeks or more. Symptoms of withdrawal include:

  • Dizziness
  • Confusion
  • Nightmares and insomnia
  • Vertigo
  • Nausea
  • Tremors
  • Gastrointestinal issues (diarrhea, nausea)
  • Flu-like symptoms
  • Anxiety
  • Agitation
  • Irritability
  • Aggression

Are There Any Side Effects I Should Be Aware of?

Possible Side effects associated with Prozac generally fall into two categories: common and rare/serious. Common side effects associated with Prozac include:

  • Headache
  • Nausea
  • Diarrhea
  • Dry Mouth
  • Increased sweating
  • Feeling nervous
  • Restlessness
  • Fatigue
  • Drowsiness
  • Difficulty sleeping (insomnia)
  • Decreased libido
  • Sexual dysfunction, such as difficulty with orgasm or ejaculatory delay

Rare but serious side effects associated with Prozac include:
Low sodium blood levels, as evidenced by:

  • Headache
  • Weakness
  • Difficulty concentrating
  • Difficulty remembering
  • Teeth grinding

Angle closure glaucoma, as evidenced by:

  • Eye pain
  • Changes in vision
  • Swelling or redness in or around eye

Serotonin syndrome, as evidenced by:

  • Shivering
  • Diarrhea
  • Confusion
  • Severe muscular tightness
  • Fever
  • Seizures
  • Death
  • QT prolongation and ventricular arrhythmia including changes in the electrical activity of your heart

Are There Any Risks Associated With Prozac?

There are several risks associated with Prozac, but the most significant risk is the black box warning of an increased risk of suicidal thinking, ideation, and behavior in children, adolescents, and young adults suffering from major depressive disorder. Patients with a diagnosis of major depressive disorder should be closely monitored while taking Prozac.

Prozac has the potential for serious drug interactions and should not be taken in conjunction with monoamine oxidase inhibitors (MAOIs), especially Pimozide and Thioridazine. Prozac should also not be taken with drugs metabolized by CYP2D6 or with tricyclic antidepressants (TCAs). Patients and prescribers should exercise care when using the drug in conjunction with benzodiazepines and other drugs that affect the central nervous system, such as Ativan and Klonopin. When combined with non-steroidal anti-inflammatories (NSAIDs), blood thinners, or other drugs that affect blood coagulation, Prozac can lead to an increased risk of bleeding. Additionally, Prozac should not be used with antipsychotic drugs or other SSRIs or herbs that are serotonergic, such as Zoloft or Paxil. Prozac has been reported to activate mania in people considered susceptible to the condition.

Who Should Not Take Prozac?

People who take certain types of drugs known to cause dangerous interactions with Prozac, including monoamine oxidase inhibitors (MAOs), especially Pimozide and Thioridazine, drugs metabolized by CYP2D6, with tricyclic antidepressants (TCAs), benzodiazepines, NSAIDs, blood thinners, and antipsychotic drugs or other SSRIs should not take Prozac. People who are allergic to Prozac or its active ingredient, fluoxetine, should not take the medication.

Other people should use caution when taking Prozac. Be sure to give your doctor a complete medical history, especially including any personal or family history examples of:

  • Bipolar disorder or manic-depressive disorder
  • Personal or family history of suicide attempts
  • Liver problems
  • Diabetes
  • Low sodium in the blood
  • Severe loss of body water/dehydration
  • Seizures
  • Stomach/intestinal ulcers
  • Glaucoma (angle-closure type)

Prozac may cause an increased risk of side effects for older adults, who are particularly at risk for bleeding and loss of coordination; loss of coordination increases the risk of falling. Older adults are also considered to be at increased risk of developing low blood sodium. 

Is Prozac Safe for Pregnant and Nursing Women?

Prozac is not considered safe for pregnant women and should only be taken during pregnancy if the potential benefits outweigh the potential for risks to the fetus. Prozac has been found to increase the risk of neonatal maladaptation syndrome, which includes symptoms of jitteriness, problems with feeding and breathing, and hypoglycemia (low blood sugar) in newborns. 

Because Prozac can be passed into breast milk, use by nursing mothers is not advised.
 

Published April 25th, 2020 by Bridget Reed
Fact Checked by Chris Riley

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