Can prozac make you crazy

9 Prozac Side Effects - Antidepressant Side Effects

Prozac was so popular after its debut in 1988 that it inspired not one but two best-selling books: Listening to Prozac and Prozac Nation (which was turned into a movie starring Christina Ricci).

It was the first SSRI, or selective-serotonin reuptake inhibitor, approved by the Federal Drug Administration, and 20 later, Prozac is still one of the top five psychiatric drugs prescribed to American adults dealing with depression and anxiety.

While most SSRIs are safe and easily tolerated, they are still psychoactive drugs—so yes, there are Prozac side effects you should know about.

Prozac stays in your system for one to two weeks, says Alison Hermann, M.D., a clinical psychiatrist at Weill Cornell Medicine and New York-Presbyterian Hospital. Which means: “If you’re someone who forgets to take your meds every day, that’s great, says Hermann. "If you’re having side effects, that can make things extra difficult.”

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If you decide to try Prozac to manage your depression or anxiety, keep an eye out for these side effects.

1. GI Distress

“By far, the most common Prozac side effects are gastrointestinal, mostly nausea and diarrhea,” says Hermann. Fun fact: “There are actually more cells that have serotonin receptors on them in your gut than there are in the brain, and since Prozac works on the serotonin system, that area can be sensitive to having more serotonin around.” These side effects tend to occur early on in treatment, and can be minimized by starting with a low dose or taking the meds with food.

Related Story
  • Study: Birth Control And Depression Not Linked

2. Changes in Arousal

No, we’re not talking about sex—yet. “Some people taking an SSRI for the first time may feel tired or a bit sedated initially, or the opposite, a little revved up or jittery,” says Murrough. “It basically occurs as the neurotransmitters in the brain get used to being exposed to something new.” Again, starting on a low dose can help mitigate this side effect.

“With serotonin syndrome, you would have symptoms like fever, agitation, increased reflexes, tremors, and you'd likely have to go to the emergency room."

3. Suicidal Thinking

Antidepressants and anti-anxiety medications are meant to help you feel better, but in some people, they can actually increase depressive thoughts. “The FDA has issued a black box warning—its strictest warning—that antidepressants can actually increase suicidal thinking in young adults and children,” says Murrough. Yes, it’s rare, but if you’re going to the doctor for depression and the medication makes you feel worse, you should absolutely talk to your doc ASAP.

4. Sexual Side Effects

These side effects tend to present once you’re on a stable dose—and the higher the dose, the more likely you are to experience them. “It can run the gamut, whether you’re a man or a woman: decreased libido, decreased genital sensations, impotence, or difficulty having an orgasm,” says Hermann. “We’re not quite sure why this happens, and anxiety and depression affect sexual functioning and sexual interest, so it can be difficult to figure out if it’s the mental disorder or the medication to blame." Still, talk to your doc if your sex drive takes a dive.

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5. Serotonin Syndrome

This is a rare side effects of medications that work on serotonin, like Prozac, but can occur if you’re on more than one drug that affects serotonin levels—which can overload your system. “With serotonin syndrome, you would have symptoms like fever, agitation, increased reflexes, tremors, sweating, dilated pupils, and diarrhea, and you’d likely have to go to the emergency room,” says Hermann.


Changes in Weight or Appetite

A study published in the journal JAMA Psychiatry found that people taking Prozac gained an average of a pound and a half over the course of a year of taking the medication.

If you notice more bruises than normal or cuts that won’t stop bleeding, definitely bring that to your doctor's attention.

7. Low Sodium Levels

“When you’re on any SSRIs, the medication can cause your kidneys to excrete more sodium,” says Hermann. “That can lead to symptoms like headaches, confusion, slurred speech, and general weakness.” She recommends that anyone taking antidepressants or anti-anxiety drugs have at least yearly blood work done to check electrolyte levels.

8. Trouble Sleeping

Like most SSRIs, Prozac can have an effect on sleep quality. “Any time you take a medication that affects the brain, there’s a potential for alterations in arousal,” says Murrough. That can manifest in abnormal dreams, difficulty falling or staying asleep, or even nighttime sweats.

9. Increased or Unusual Bruising or Bleeding

“SSRIs can affect the way platelets aggregate to stop bleeding in some people,” says Murrough. This is almost nonexistent in the general population, but there is a risk of bleeding more easily while taking Prozac. This would be most likely to occur in older patients, says Murrough—but if you notice more bruises than normal or cuts that won’t stop bleeding, definitely bring that to your doctor’s attention.

Ashley Mateo

Ashley Mateo is a writer, editor, and UESCA- and RRCA-certified running coach who has contributed to Runner’s World, Bicycling, Women's Health, Health, Shape, Self, and more. She’ll go anywhere in the world once—even if it’s just for a good story. Also into: good pizza, good beer, and good photos.

Prozac side effects and how to avoid them

Prozac increases serotonin in the brain, allowing people to better manage mood and impulses

Prozac side effects | Serious side effects | Insomnia | Diarrhea | Erectile dysfunction | Angle-closure glaucoma | Suicide | How long do side effects last? | Warnings | Interactions | How to avoid side effects

Prozac is a brand-name prescription drug used for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), panic disorder, binge eating disorder, and bulimia nervosa. Prozac is also combined with the antipsychotic medication olanzapine for treatment-resistant depression or depressive episodes in people diagnosed with bipolar disorder. 

Prozac is also commonly used off-label to treat premenstrual dysphoric disorder, generalized anxiety disorder, social anxiety disorder, post-traumatic stress disorder, borderline personality disorder, and other conditions.

The active ingredient in Prozac, fluoxetine hydrochloride, is a selective serotonin reuptake inhibitor (SSRI). SSRIs increase serotonin in the brain, allowing people to better manage mood and impulses due to more efficient nerve activity. As with all medicines that affect the brain, Prozac can cause problems due to side effects, pre-existing conditions, or drug interactions, but there are ways to avoid or minimize these problems.

RELATED: Learn more about Prozac

Common side effects of Prozac

The most common side effects of Prozac are:

  • Trouble sleeping
  • Nausea
  • Headache
  • Fatigue
  • Diarrhea
  • Loss of appetite
  • Drowsiness
  • Dry mouth
  • Weight loss
  • Weight gain

Serious side effects of Prozac

The most serious side effects of fluoxetine include:

  • Drug-induced movement problems (extrapyramidal effects)
  • Suicidal thoughts and behaviors
  • Irregular heartbeats (QT prolongation) and heart problems
  • Seizures
  • Bleeding
  • Serotonin syndrome
  • Mania or hypomania
  • Low sodium
  • Low blood sugar
  • Angle-closure glaucoma
  • Pulmonary fibrosis
  • Prolonged and painful erections
  • Severe allergic reactions

Prozac and insomnia

In clinical trials, 10% to 33% of people taking Prozac experienced trouble sleeping. If Prozac causes insomnia, patients will initially be advised to take the daily dose early in the morning. If insomnia persists, a healthcare professional will typically prescribe mirtazapine, trazodone, or a sedative along with Prozac. Both mirtazapine and trazodone are antidepressants like Prozac, but they also have powerful sedative effects.

Prozac and diarrhea

Diarrhea was experienced by 8% to 18% of people taking Prozac during its initial clinical trials. Gastrointestinal side effects, however, may get better as the body adjusts to Prozac. If diarrhea persists, a healthcare provider may prescribe mirtazapine along with Prozac. Diarrhea could, however, be a potentially serious problem in any person with an electrolyte imbalance.

Prozac and erectile dysfunction

About 1% to 7% of patients report erectile dysfunction (ED) when taking Prozac. Another 2% to 8% report ejaculation dysfunction. A healthcare provider may prescribe Wellbutrin (bupropion) or an ED medication such as Viagra (sildenafil) or Cialis (tadalafil) for erectile dysfunction. Saffron may help with ejaculation dysfunction. However, erectile dysfunction is a common side effect of SSRIs, so a healthcare provider may need to switch to another type of antidepressant.

Prozac and angle-closure glaucoma

Angle-closure glaucoma is caused by the closing of the opening (angle) between the iris and the cornea that drains fluid from the inside of the eye. Prozac causes pupils to dilate, so it may close that opening in people with uncorrected “narrow angles.” Pressure builds up behind the eye very rapidly and can result in permanent vision loss in less than a day. The incidence is unknown, but immediately stop taking Prozac and get emergency medical attention at any sign of angle-closure glaucoma such as:

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

Prozac and suicide

Prozac and other SSRIs have a black box warning stating that taking the drug can cause children, teens, and young adults to become suicidal. The overall incidence is between 0.1% and 1%, but older adults are at a considerably lower risk. It is important that young people taking Prozac are monitored for signs of suicidality and other behaviors such as:

  • New or sudden changes in mood or behavior
  • Suicide attempts
  • Acting on dangerous impulses
  • Acting aggressively or violently
  • Thoughts about suicide or dying
  • Trouble sleeping
  • New or worsening depression or anxiety
  • Panic attacks
  • Agitation, restlessness, irritability, or anger
  • Unusual behaviors
  • Extreme increase in activity or talking

How long do side effects last?

Many common side effects will improve as the body gets used to the medicine. Fluoxetine has a half-life of two to four days, but it is converted by the body into another drug that works just like fluoxetine. That drug, norfluoxetine, has a half-life of four to 16 days. That means that the most common side effects can take anywhere from a week to a month to fade after the last dose has been taken.

Other side effects such as allergic reactions, angle-closure glaucoma, heart problems, severely low sodium, or serotonin syndrome will require medical attention to get better. Some of the most severe, such as heart problems or angle-closure glaucoma, may have life-long complications. 

Prozac contraindications & warnings

Prozac may cause problems in some people because of pre-existing physical or medical conditions.

Abuse and dependence

The U.S. Food and Drug Administration (FDA) has not classified Prozac as a controlled substance and no studies have been completed about its potential for abuse or physical dependence. Prozac was first introduced in 1987. Since then, there has been no evidence that Prozac causes withdrawal symptoms or addiction, even in patients who have been treated for fluoxetine abuse.


An overdose of Prozac can cause serious and lifelong medical problems including death. Get emergency medical treatment if an overdose is expected or if any symptoms of an overdose are experienced. The most common symptoms of fluoxetine overdose are:

  • Seizures
  • Sleepiness
  • Fast heartbeat
  • Nausea
  • Vomiting


The only people who can never take Prozac are those with allergies to fluoxetine or any of the inactive ingredients in Prozac capsules.

Pre-existing conditions put people at an increased risk of adverse effects or other problems if they take Prozac. Healthcare providers will be cautious using Prozac in these people. Extra monitoring or tests may be needed to identify problems before they become worse. Other restrictions include:

  • People younger than the age of 25 years should be carefully watched for signs of worsening depression, unusual behaviors, mood changes, or suicidal thoughts or behaviors.  
  • Prozac may require regular monitoring and testing in people with heart problems including a history of irregular heartbeats, a family history of heart rhythm abnormalities, congestive heart failure, recent heart attacks, or electrolyte abnormalities. 
  • People who are “poor CYP2D6 metabolizers”—are at a higher risk for heart problems. They may require careful monitoring and dose adjustments.
  • Seniors and people with blood volume depletion require careful dosing and regular monitoring. 
  • For bipolar patients, Prozac is usually prescribed with the antipsychotic olanzapine to prevent manic or hypomanic episodes.
  • People with a history of seizures will require monitoring. 
  • People with uncorrected narrow angles are at a higher risk of narrow-angle glaucoma when taking Prozac.
  • People with diabetes will need regular blood glucose monitoring.  
  • People with bleeding problems or taking blood-thinning drugs may need to have regular INR tests, particularly when first taking Prozac.

Pregnancy and nursing

There is no evidence that fluoxetine increases the risk of birth defects or miscarriages. However, women may be advised not to take Prozac in the third trimester. There is a risk that the baby will be born with complications such as trouble breathing, withdrawal symptoms, or serotonin syndrome.

Women can take Prozac while breastfeeding, but they need to monitor the baby for possible side effects. Both fluoxetine and its active metabolite are present in breast milk. Babies exposed to the drug may experience agitation, fussiness, feeding problems, or insufficient weight gain.


The U.S. Food and Drug Administration (FDA) has approved Prozac as safe and effective for children as young as 8 years of age for treatment of depression and as young as 7 years of age for obsessive-compulsive disorder. Antidepressants, however, are associated with a higher risk of worsening depression and suicidality when given to children, so caregivers should monitor the child for any behavior changes, mood changes, aggression, or thoughts about suicide or death.


People older than 65 can take Prozac in the same doses as younger adults, but they may need to be monitored or tested regularly for low sodium or other possible side effects.

Prozac interactions

Prozac has some drug interactions with both over-the-counter and prescription drugs. Most are minor, but a few are serious enough that patients taking Prozac should be aware of them.

  • Prozac is never given along with monoamine oxidase inhibitors (MAOIs) such as Marplan (isocarboxazid), phenelzine, tranylcypromine, and selegiline.
  • Prozac is never combined with the antipsychotics pimozide and thioridazine. For the same reason, it is not combined with Cerdelga (eliglustat), a drug used to treat a rare hereditary disorder. Other drugs that affect heart rhythm, such as antiarrhythmics, will need to be used cautiously with regular ECG tests.
  • Because of the risk for serotonin syndrome, drugs that raise serotonin levels—called serotonergic drugs—should be avoided or used carefully. These include: 
    • Other SSRIs such as Celexa (citalopram), Zoloft (sertraline), Paxil (paroxetine), and others
    • SNRIs such as Effexor (venlafaxine)
    • Tricyclic antidepressants
    • Anxiety medications
    • Antipsychotics
    • Bipolar disorder medications such as lithium
    • Migraine drugs
    • Amphetamines
    • Opioids
    • Seizure medications 
    • Anti-nausea medications
    • Parkinson’s disease medications
    • Common over-the-counter supplements such as tryptophan and St. John’s wort
  • Fluoxetine is broken down by the CYP2D6 liver enzyme. Drugs that block this enzyme will cause fluoxetine to increase to hazardous levels in the body, raising the risk of side effects and heart abnormalities.
  • Prozac must be used carefully with blood thinners such as warfarin. NSAIDs (nonsteroidal anti-inflammatory drugs) such as aspirin, ibuprofen, or naproxen also thin the blood, so bleeding episodes—particularly gastrointestinal bleeding—are more likely if they’re taken along with Prozac.

How to avoid Prozac side effects

A few guidelines can help minimize Prozac side effects:

1. Take Prozac as directed

Make sure to read the entire medication guide before taking this medicine. Take the dose as prescribed, usually 20–80 mg once daily. If a dose is missed, take it as soon as it’s remembered. If it’s nearly time to take the next dose, skip the missed dose and take the next dose as scheduled.  

2. Tell the doctor about all medical conditions

The best way to prevent adverse effects is to tell the prescribing healthcare professional about all past and present medical conditions, especially:

  • Liver problems
  • Kidney problems
  • Heart problems
  • History of seizures
  • Mania or bipolar disorder
  • Stroke
  • High blood pressure
  • Bleeding problems
  • Diabetes
  • Narrow-angle glaucoma
  • Electroconvulsive therapy (ECT)
  • Pregnancy or pregnancy plans
  • Breastfeeding or breastfeeding plans

3. Tell the doctor about all medications being taken

Drug interactions can also cause side effects, so the healthcare professional prescribing Prozac should know about all prescription and over-the-counter medications and supplements being taken, particularly:

  • MAO inhibitors
  • Medicines that treat mood, anxiety, psychosis, bipolar disorder, or other mental illnesses 
  • Amphetamines
  • Migraine medications called triptans
  • Opioids (especially tramadol or fentanyl)
  • Blood thinners such as warfarin
  • Any medication containing fluoxetine such as Symbyax or Sarafem
  • Supplements or herbal remedies like St. John’s wort or tryptophan.

4. Take Prozac in the morning

To minimize insomnia, take Prozac as early as possible in the morning.

5. Do not drink alcohol

Do not drink when taking Prozac. Combining alcohol with Prozac will only worsen sleepiness and mental impairment caused by the drug. 

6. Be careful about driving and other risky activities

Prozac can cause sleepiness and affect decision-making and response time. Avoid driving or risky activities until the effects of Prozac are well understood.

7. Eat a healthy diet

To avoid weight loss, eat a healthy diet. If weight loss becomes a problem, consult with a dietitian or nutritionist.

8. Avoid NSAIDs

Nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen can raise the risk of gastrointestinal bleeding, stomach pain, and bleeding episodes when taking Prozac. Consider using alternatives like acetaminophen instead.

9. Do not stop taking Prozac

The sudden discontinuation of Prozac may cause unpleasant side effects, so consult with a healthcare provider for medical advice if the drug is not working or the side effects are hard to bear.  

Related resources for Prozac side effects:

  • Fluoxetine, StatPearls
  • Fluoxetine, Prescriber’s Digital Reference
  • Fluoxetine abuse, Mayo Clinic Proceedings
  • “Narrow angles”: A tip-off to eyesight risk, Harvard Health Publishing
  • Prozac, Epocrates
  • Prozac prescribing information, U.S. National Library of Medicine
  • Sexual dysfunction in selective serotonin reuptake inhibitors (SSRIs) and potential solutions: A narrative literature review, The Mental Health Clinician

What they treat us with: Prozac. From depression to bulimia


16:00, December 14, 2017

Analysis of one of the popular antidepressants how it is customary to treat them and whether the antidepressant Prozac works, read in the new material of the heading “How we are treated”.

Prozac is on the list of the most important, safest and most effective (including from an economic point of view) drugs according to the World Health Organization. However, as we remember after the article with the analysis of Tamiflu, this does not guarantee its effectiveness. nine0003

Prozac is prescribed for the treatment of depression, obsessive-compulsive disorders, bulimia nervosa. If you know very well what it is, you can immediately skip to the “from what, from what” part.

When life is not nice

Depression is called depression, loss of interest in what used to make the patient happy. According to the international classification of diseases ICD-10, the main criteria by which such a diagnosis can be made include depressed mood for more than two weeks, loss of strength and consistently high fatigue (more than a month) and anhedonia (the inability to enjoy what used to bring joy). Doctors consider additional criteria for depression to be pessimism, low self-esteem, thoughts of death and suicide, appetite disturbances (weight loss or overeating), sleep problems, constant fears and anxieties, feelings of worthlessness and guilt, inability to concentrate, and a constant sweet taste in the mouth. These symptoms are unlikely to occur simultaneously (for example, fatigue and apathy may predominate in some cases, while anxiety and guilt may prevail in others), therefore, in order to diagnose depression, the patient's condition must meet at least two main criteria and three additional ones. At the same time, according to the definition of the US National Institute of Mental Health, such a state should last quite a long time (more than two weeks). nine0003

Severe depression (clinical) includes a complex set of symptoms called major depressive disorder and may sometimes not be accompanied by low mood at all. However, because of her, the patient is physically unable to live and work normally, and the comments of those around him in the spirit of “he just can’t pull himself together” or “enough to turn sour that he spread snot” sound like a mockery. Such phrases stigmatize depression, blaming a person for his condition, while he himself will not be able to cope and needs treatment. To diagnose major depressive disorder, there is a whole questionnaire of major depression compiled by the World Health Organization. Also, depressive disorders include other conditions accompanied by depression, such as dysthymia (daily low mood and mild symptoms of depression for two years or more). nine0003

The causes of depression can be very different: somatic (due to diseases of the body), psychological (after strong dramatic experiences, such as the death of a relative) and iatrogenic (as a side effect of certain drugs). As strange as it would be to provide first aid to a victim of an electric shock without removing the wire from him, it is difficult to cure the symptoms of depression without eliminating its cause or changing the lifestyle that led the patient to such a state. If the patient lacks some essential substances (for example, tryptophan), it is important to make up for their lack, and not just fight the depressed mood with drugs. If he has some kind of psychological trauma, the help of a psychotherapist will be required. And for a person whose depression is provoked by hormonal disorders, neurological diseases, heart disease, diabetes, or even cancer (and this happens), it is more important to cure the disease itself, and symptomatic treatment of depression will be a secondary goal. nine0003

When you can't stop

Obsessive-compulsive disorder, or OCD (also called obsessive-compulsive disorder), consists of two mandatory components: obsessions (obsessive anxious or frightening thoughts) and compulsions (compulsive actions). A classic example is cleanliness-related OCD, where a person is afraid of contamination or contamination by microorganisms. Such thoughts and fears are called obsessions. In order to protect themselves from them, a person will worry too much about cleanliness, such as constantly washing their hands. Any contact with a non-sterile, according to the patient, object, plunges such a person into horror. And if you can’t wash your hands again, he will experience real suffering. nine0003

You can learn how to deal with medications on your own in the author's online course "How we are treated" by the editor of Indicator.Ru Ekaterina Mishchenko:

Such "protective" behavior is called compulsion. The desire for cleanliness can be understood if a person is in conditions of complete unsanitary conditions or, on the contrary, wants to maintain sterile conditions somewhere in the operating room. But if the action loses its true meaning and becomes a mandatory ritual, it becomes a compulsion. nine0003

However, OCD can manifest itself not only as a fear of pollution, but also as excessive superstition, fear of losing a necessary object, sexual or religious obsessive thoughts and related actions. Their reasons may lie in several areas: biological and psychological. The first includes diseases and features of the nervous system, lack of neurotransmitters (biologically active substances that ensure the transmission of a nerve impulse from one neuron to another, for example, dopamine or serotonin), genetic predisposition (mutations in the hSERT gene encoding the serotonin carrier protein and located on 17 -th chromosome). nine0003

There is also an infectious theory of the development of OCD, associated with the fact that in children it sometimes occurs after infection with streptococcus. This theory is called PANDAS - an abbreviation for the English Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections, which translates as "Children's autoimmune neuropsychiatric disorders associated with streptococcal infections." The cause of this syndrome may be an attack of its own antibodies produced against streptococcus on the patient's nerve cells. However, this theory has not yet been confirmed. nine0003

Another group of explanations for the development of OCD is psychological. They go back to the theories of the beginning of the last century (from Freud to Pavlov). Mayakovsky's father died of blood poisoning after being injected with a binder, so it is believed that the poet also showed a pathological love for cleanliness. But you don't have to be a futurist poet to experience the full benefits of OCD: even dogs and cats suffer from it. Only in them this is expressed in the endless licking of wool and attempts to catch their tail. nine0003

The Yale-Brown scale is used to diagnose obsessive-compulsive disorder. In the fight against OCD, the method of psychological persuasion can be useful: patients are patiently explained that if they skip the “ritual” once, nothing terrible will happen. But drugs are also used in treatment.

When you are how you eat

Bulimia nervosa (third indication for Prozac) is a binge eating disorder. The main signs of bulimia are uncontrolled eating in large quantities, obsession with excess weight (calorie counting, attempts to induce vomiting after eating, fasting, use of laxatives), low self-esteem, low blood pressure. Other symptoms are sudden changes in body weight, kidney problems and dehydration, enlarged salivary glands, heartburn after eating, and inflammation of the esophagus. Due to provoking vomiting, hydrochloric acid from the stomach constantly enters the oral cavity of patients, which can lead to grinding of tooth enamel and ulcers on the mucous membrane. According to the DSM-5 classification of diseases, uncontrolled consumption of large amounts of food and the simultaneous use of various drastic measures for weight loss is the main criterion for diagnosing bulimia nervosa. nine0003

Video about bulimia on the educational medical resource Open Osmosis (USA)

The causes of bulimia can be either biological (incorrect levels of hormones or neurotransmitters, including serotonin) or social. The importance of the latter is highlighted, for example, in a high-profile study among teenage girls in Fiji, which showed a sharp increase in cases of intentional bowel cleansing for weight loss in just three years (from 1995 to 1998) after television appeared in the province. Perhaps the desire to be like models from the screens and covers really pushes for such behavior. nine0003

Bulimia can often be associated with other psychiatric disorders (depression, anxiety disorders, sleep disorders). According to a study by the New York State Psychiatric Institute and Columbia University, 70% of people with bulimia have ever experienced depression, compared with just over 25% in the general population.

Bulimia itself is not very common, and it can be more difficult to diagnose than the same anorexia, because changes in body weight in bulimia are less sharp and noticeable. For diagnosis, the food attitude test, developed by the Clark Institute of Psychiatry at the University of Toronto, and other tests based on it, are used. But (as with the tests for OCD and depression above), its result only indicates the likelihood that the patient has developed a disorder, but does not allow for a definitive diagnosis, especially for oneself. nine0003

From what, from what

What is a medicine that is prescribed for three types of disorders at once? The active ingredient in Prozac is fluoxetine. The patent for Prozac expired back in 2001, so many generics are available in pharmacies - cheaper copies that use the same active ingredient, but are not as well studied and may differ slightly from the original. These drugs include Fluoxetine, Prodel, Profluzak, Fluval.

Fluoxetine, discovered and marketed by Eli Lilly and Company, belongs to a group of antidepressants called selective serotonin reuptake inhibitors. This group is considered third-generation antidepressants, fairly well tolerated and without significant side effects. nine0003

Fluoxetine is readily absorbed into the blood, can bind to plasma proteins and accumulate in body tissues. It also penetrates the blood-brain barrier, which protects the nervous system and brain from many substances circulating in the blood. There, in the nervous system, it works in the synaptic cleft we have already mentioned, preventing the excess serotonin ejected from the synapse from returning to the neurotransmitter. Because of this, serotonin is longer present in the synaptic cleft and can bind to receptors. How exactly fluoxetine achieves this effect is not clear even to manufacturers, but it is known that it has little effect on the work of other neurotransmitters. However, at high doses, fluoxetine increases adrenaline and dopamine levels, as studies in rat brain tissue show. nine0003

Fluoxetine and its metabolite, norfluoxetine, can interfere with each other's actions. Because of this, according to scientists from the Institute of Research Medicine in Barcelona, ​​a constant concentration of fluoxetine in the blood is achieved only after four weeks of taking the drug. Similarly, the effects of taking the medicine do not disappear immediately. Associated with this is the difficulty in selecting the required dose for a particular patient.

Serotonin itself, which is absolutely incorrectly called the “happiness hormone” (hormones are produced in one organ of the body, but perform their function in another, serotonin in this context simply conducts nerve impulses in the brain regions responsible for good mood, and is produced there well), in fact, it performs much more functions. Yes, it affects mood, sleep, and appetite, so some cases of depression, bulimia nervosa, and OCD may be caused by insufficient production of this neurotransmitter and corrected with serotonin reuptake inhibitors. But in addition, platelets can actively capture it and affect blood clotting. Serotonin is also involved in the processes of memorization and learning. At the same time, not only vertebrate animals can produce it: according to a study by Chinese and American scientists, the pain from an insect bite is largely due to the presence of serotonin in the poison, and the dysentery amoeba, according to an article in Science, can cause diarrhea by releasing serotonin in our intestines. nine0003

The lists (not) included

But all these are just mechanisms, and besides, they have not been studied to the smallest detail. To understand how this works in real people and how often it helps, let's turn to clinical trials. However, anyone who enters the combination “fluoxetine depression double blind randomized controlled” into the PubMed scientific article database and filters clinical trial (clinical trial) will see more than 558 articles, up to work comparing the effectiveness of Prozac and homeopathy. nine0003

Double-blind, randomized, placebo-controlled method is a method of clinical drug research in which the subjects are not privy to important details of the study being conducted. “Double-blind” means that neither the subjects nor the experimenters know who is being treated with what, “randomized” means that the distribution into groups is random, and placebo is used to show that the effect of the drug is not based on autosuggestion and that this medicine helps better than a tablet without active substance. This method prevents subjective distortion of the results. Sometimes the control group is given another drug with already proven efficacy, rather than a placebo, to show that the drug not only treats better than nothing, but also outperforms analogues. nine0003



No living person can analyze them within an adequate period of time. And even Cochrane reviews can be found as many as 36 (that's really a lot), although not all of them consider the action of fluoxetine for its direct indications (depression, bulimia and obsessive-compulsive disorder).

The Cochrane Library is a database of the Cochrane Collaboration, an international non-profit organization involved in the development of World Health Organization guidelines. The name of the organization comes from the name of its founder, the 20th-century Scottish medical scientist Archibald Cochrane, who championed the need for evidence-based medicine and the conduct of competent clinical trials and wrote the book Efficiency and Efficiency: Random Reflections on Public Health. Medical scientists and pharmacists consider the Cochrane Database one of the most authoritative sources of such information: the publications included in it have been selected according to the standards of evidence-based medicine and report the results of randomized, double-blind, placebo-controlled clinical trials. nine0003



One of them is dedicated to antidepressants used against bulimia nervosa. Although in general the authors note that there is little data on this topic, fluoxetine (for which there were only five randomized double-blind controlled trials in 2003) is recognized as a leader in this direction. However, the authors refuse to recommend this medicine in the conclusion, arguing that not all clinical trial data have been published and are available for consideration. nine0003

The authors of a 2008 review reviewed the benefits of serotonin reuptake inhibitors (including fluoxetine) in obsessive-compulsive disorder and concluded that they help better than placebo, and the associated side effects are much more significant, among which nausea is most common , insomnia and headache. According to a 2013 review, the usefulness of this same group of drugs in autism and related OCD is unclear, and the data are insufficient to conclude.

The most popular subject of fluoxetine reviews was the fight against depression. But the authors of most of them note the lack of data (for example, in this 2013 review). In a broad inclusion criteria review of 1177 randomized controlled trials of fluoxetine for depression in adults, the authors conclude that it is about as effective as other antidepressants but less toxic. However, they warn against hasty decisions, since most of the studies were conducted on small groups of people (100 or less) and were funded by the manufacturer, which is more profitable to publish only positive results, hiding information about failures. Data on postpartum depression are also found to be insufficient and inconsistent. The same issues are highlighted by a review of articles on the effectiveness of antidepressants against dementia-related senile depression. nine0003

Indicator.Ru concludes: one of the best stimulant antidepressants is still not perfect

A large number of studies confirm the effectiveness of fluoxetine, a key component of Prozac. But part of the reviews of the Cochrane Collaboration note that not all trial data have been published by manufacturers. And this accusation is not an empty phrase: according to Eli Lilly's internal documents, manufacturers during trials often attributed suicide cases to worsening depression or overdosing on the drug. nine0003

As a result, following numerous reports of suicide by patients prescribed this drug, the US Food and Drug Administration (FDA) has issued a warning label to the drug's packaging.

This does not mean that the harm from the medicine always outweighs its benefit, but such dishonest behavior of manufacturers does not allow us to assess the risks more accurately. Given the difficulty with the selection of an individual dose and the slow effect, adjusting the dosage is really not easy. nine0003

Prozac is also classified as a serotonin reuptake inhibitor, but if the cause of your condition is something else, you need to pay more attention to finding and eliminating them than fighting depression. As we wrote above, somatic diseases (for example, cirrhosis of the liver, cancer or diabetes), and even a lack of vitamins, can also cause depression. In addition, depression or another disorder may be the result of psychological trauma that will be difficult to deal with without psychotherapy. nine0003

All this suggests that the drug should be used under the supervision of a doctor (most likely, it will not be sold without a prescription), and that its action alone may not be enough for a complete recovery. And don't forget that serotonin is involved in many other processes in the body. Therefore, you should not use the drug in violation of the functions of the liver and kidneys, an increased risk of thrombosis, and not only during pregnancy and lactation. With manic states and suicidal moods, it is also better to abandon the drug. If you notice allergic reactions or nausea and headache, you need to see a doctor and ask if you should stop taking the medicine. nine0003

Our advice cannot be compared to a doctor's prescription. Before you start taking this or that drug, be sure to consult a specialist.

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Author: Ekaterina Mishchenko

Tags #How we are treated

Depression under repression - Money - Kommersant

4K 7 min. ... nine0159

Happiness Pill
In 1957, a psychiatric hospital in Switzerland received a new drug for schizophrenia. The patients obediently swallowed the pills, the doctors waited for the results, but there was no healing. However, doctors noticed another curious feature: after taking the new drug, sad and inhibited patients became cheerful and active for a while. Almost at the same time, another clinic was testing a new drug for the treatment of tuberculosis. It did not affect Koch's wands in any way, but for those who received it, the feeling of constant anxiety for their lives was replaced by serenity and calmness. So, thanks to an accident, noticed in time by doctors, drugs were born, later called antidepressants. nine0160 Having studied the mechanism of action of "happiness pills", scientists have understood the very cause of depression. Studies have shown that depression occurs when the metabolism of serotonin (a hormone responsible for a stable mood in a person) is disturbed in the body, and to eliminate it, it is enough to increase the content of this hormone in the human body.
However, the first antidepressants turned out to be not a panacea at all, since they had a lot of unpleasant side effects: dry mouth, constipation, sweating, weakness, insomnia, heart rhythm disturbances, decreased pressure, problems with the liver and kidneys. In addition, those wishing to get rid of depression had to follow a diet: the drugs were incompatible with many foods (cheese, smoked meats, fish, beer, red wine). nine0160 Scientists have been perfecting "happiness pills" for 30 years, until the American pharmaceutical company Eli Lilly patented the drug "Prozac" in the late 80s. It became the first drug of a new generation of antidepressants, scientifically called "serotonin reuptake inhibitors". In the process of metabolism, serotonin is produced by some cells and immediately absorbed by others. Prozac works by blocking the uptake of serotonin.
nine0160 Return of the Sad Parrot

From an ordinary bad mood, depression differs in a protracted nature. Medical reference books say that if for at least two weeks you experience a feeling of worthlessness or guilt, suddenly gaining weight or losing weight, suffer from insomnia, loss of strength or, conversely, unreasonable excitement, easily get irritated, or, God forbid, you are thinking of committing suicide - you have all the symptoms of depression. As it turned out, such sensations were familiar to a huge number of people. So when at 19In 88, the first packages of Prozac appeared in pharmacies, in the annotation to which it was claimed that it was able to relieve the symptoms of depression and give self-confidence, the new medicine was literally swept off the shelves: in the first year, sales amounted to about $ 2 million. gave in the United States - almost without exception, Americans found symptoms of depression in themselves.
And America "hooked" on Prozac - it was bought by the old and the young, "shopaholics" and gamers, victims of bulimia and anorexia. Americans enthusiastically told their friends about the miraculous medicine, and they went to psychiatrists with a request to write them a prescription for happiness. Soon, not only psychiatrists, but also therapists began to prescribe antidepressants, since, according to doctors, "depression can be disguised as various physical ailments." It even got to the point that veterinarians began prescribing a new drug for their patients, after which messages appeared in the yellow press, such as “Many parrot after a course of Prozac cheered up and covered with feathers again” or “Sad poodle became cheerful again under the influence of antidepressants.” nine0160 At the same time, with the advent of Prozac, humanity took a fresh look at depression - this disease has become fashionable. Depression was tacitly declared to be an essential attribute of the young and progressive. Depression began to talk a lot, write, shoot television stories and films. The latest creation on this topic is the film by Norwegian director Erik Skjoldberg "Prozac Nation" with Christina Ricci in the title role. The script for the film is based on the memoirs of the famous music critic Elisabeth Wurzel, the full title of which is Prozac: The Young and the Depressed in America. nine0160
Happy to death
Under the influence of advertising, consumers forgot that antidepressants are not harmless valerian at all, but a drug for the treatment of severe mental illness. Prozac and similar drugs were drunk not only to improve mood, but simply to get rid of insomnia or even lose weight. In its ten years of existence, antidepressants have been prescribed to approximately 40 million people worldwide. The popularity of Prozac led to the fact that in America it was dubbed the "drug in the law", and people who use it began to be called happy fools (happy fools). nine0160 However, the euphoria subsided when it became clear that the “happiness pills” were far from harmless. In 2001, two scandals erupted almost simultaneously in Australia and the United States - American David Snell killed his entire family of three, and Australian David Hawkins killed his wife. After that, both took their own lives. The investigation revealed that they were being treated with antidepressants. Western scientists explained this case as follows: they say, patients with depression often want to die, but do not find the strength in themselves, and after taking antidepressants they have strength, which leads to tragedy. After showing the Hawkins and Snell trials on the BBC, patients taking antidepressants and their families reported 16 suicides, 47 suicide attempts, and 92 cases of aggressive behavior.
Meanwhile, Alexander Tesler, director of the Center for Psychotherapy and Reflexology of the Russian Academy of Medical Sciences, is sure that only abrupt withdrawal of an antidepressant can lead to suicide: “The decision to prescribe and cancel antidepressants should be made only by a doctor. The dose of the drug should be reduced gradually, then there will be no withdrawal syndrome. patients leads to the fact that depression rolls again, and a person in this state is quite capable of laying hands on himself. “I have a patient,” continued Academician Tesler, “who was treated with antidepressants, but she had problems with her libido from this, and her partner forced her to give up the pills. As a result, a week later she came to me absolutely broken, in the deepest depression ". nine0160 By the way, accusations of a decrease in libido are heard against “happiness pills” regularly. However, most manufacturers of antidepressants honestly warn about this in the annotation to the drug. As well as other side effects: migraine, amnesia, hallucinations, dizziness, weight loss, nausea, diarrhea, tremor, urticaria, tachycardia, edema, bronchospasm.
Alexander Tesler: I recently had a patient with depression who said that he would live in this world for exactly a month in order to have time to finish all his affairs, after which he would consciously die. I warned him that this month would be very difficult for him, so it would be better if he took antidepressants. But he objected: "What are you? It's so bad for the liver!" After that, I calmly let him go - a person who thinks so much about his liver is unlikely to seriously intend to harm his life. nine0159

With drink around the neck
It should be noted that mankind from time immemorial has tried to find a remedy for the blues. Before the advent of antidepressants, they tried to get rid of it with the help of drugs that have a stimulating effect (coffee, ginseng, and even opium), and to reduce anxiety, they used ordinary valerian or bromine salts. In Russia, vodka is considered a traditional "antidepressant", which most of the fellow citizens use to drive away sadness and melancholy. At first, alcohol really helps to cope with emotions, but over time, on the contrary, it begins to work as a powerful depressogen. That is why almost all psychological centers treat alcohol dependence along with depression. nine0160 Meanwhile, American values—including the fashion for taking antidepressants—have long since taken root in Russia. Alexander Tesler: One day I called a friend of mine in California and heard him talking harshly to his subordinates. When I asked what happened, he replied: "I forgot to take my morning Prozac." In the United States, successful people have long understood that no matter what happens, they must be "afloat." Now the Russians have come to the same conclusion.
"A real boom in antidepressants has begun in Russia," says Svetlana Grudacheva, a leading analyst at the Pharmexpert marketing research center.million in 2001 to $26.8 million in 2003. There are 50 companies in this market, 10 of which are domestic."
According to statistics, 11.5 million Russians suffer from depression, only a third of whom receive full-fledged treatment. The rest are engaged in getting rid of depression on their own - some drugs are sold in pharmacies without a prescription. According to the principle of action, all drugs are almost the same: among the most popular are Zoloft, Paxil, Selex, Luvox, Russian pyrazidol, Azafen. Domestic antidepressants cost about $3.5 (but their market share is only 8%), the price of imported drugs is from $11 to $50 per pack (a monthly course of treatment involves taking two packs). nine0160 Alexander Tesler: Today, a wealthy Russian believes that in order to be calm and stable, he must visit a psychoanalyst. I have several perfectly healthy clients whom I meet once a week - they just need to talk to me about their problems. Once I talked for two hours with a businesswoman about her family and friends, after which she suddenly said: "Talking with you helped me make a decision - I'm buying a plant."
Experts note that depression is often “discovered” by completely normal people. After that, they begin to treat a non-existent ailment with the help of "happiness pills". However, doctors emphasize that only a psychiatrist can diagnose depression and prescribe a course of treatment - self-medication can lead to an aggravation of the disease.
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