How long does it take prozac to kick in

Common questions about fluoxetine - NHS

How does fluoxetine work?

Fluoxetine is one of a group of antidepressants called selective serotonin reuptake inhibitors, or SSRIs. These medicines are thought to work by increasing the levels of serotonin in the brain. Serotonin is thought to have a good influence on mood, emotion and sleep.

When will I feel better?

You may see an improvement in your symptoms after around 1 to 2 weeks, although it usually takes between 4 and 6 weeks before you feel the full benefits. That's because it takes around a week for fluoxetine levels to build up in your body, and then a few weeks longer for your body to adapt and get used to it.

Do not stop taking fluoxetine after 1 to 2 weeks jus because you feel it is not helping your symptoms. Give the medicine at least 6 weeks to work.

How will it make me feel?

Antidepressants like fluoxetine help to improve your mood so you feel better.

You may notice that you sleep better and get on with people more easily because you're less anxious. You will hopefully feel less worried.

Fluoxetine will not change your personality, it will simply help you feel like yourself again.

Do not expect to feel better overnight, though. Some people feel worse during the first few weeks of treatment before they begin to feel better.

Are there any long-term side effects?

For most people, fluoxetine is safe to take for a long time.

A few people may get sexual side effects, such as problems getting an erection or a lower sex drive. In some cases, these can continue even after stopping the medicine. Speak to your doctor if you are worried.

There do not seem to be any lasting harmful effects from taking fluoxetine for many months and years.

What will happen if I stop taking it?

If you’ve been feeling better for 6 months or more, your doctor may suggest coming off fluoxetine.

Your doctor will probably recommend reducing your dose gradually over several weeks if you have been taking fluoxetine for a long time.

This helps to prevent any withdrawal symptoms. This sometimes happens as a reaction to coming off the medicine. These include:

feeling dizzy
feeling sick
numbness or tingling in the hands or feet
trouble sleeping
feeling agitated or anxious
headaches
shaking

Important: Important

Do not stop taking fluoxetine suddenly, or without talking to your doctor first.

How does fluoxetine compare with other antidepressants?

Fluoxetine is no better or worse than other antidepressants. However, sometimes people respond better to one antidepressant than to another. Talk to your doctor if you are not feeling any better after 6 weeks.

Are there other treatments for depression that will help?

Antidepressants, including fluoxetine, are just one of several approaches to treating depression. Other potential treatments include:

talking therapy (such as cognitive behavioural therapy)
exercise programmes
help to get a good night's sleep

Choosing a treatment that's most suitable for you depends on:

how long you've had depression
your symptoms
whether you've had any previous periods of depression
whether previous treatment has worked
how likely you are to stick with your treatment
the potential side effects
your preferences and priorities

Will it affect my sex life?

The good effects of fluoxetine may, after a while, improve your sex life as your mood lifts and you become interested in life and relationships again.

Some of the possible negative effects include:

painful erections, problems with getting an erection and ejaculating
some vaginal bleeding and not reaching orgasm the same way as before
having a lower sex drive

Sexual side effects usually pass after the first couple of weeks. However, very rarely, they can be long lasting and may not get better even after stopping the medicine.

If these happen and are a problem for you, go back to your doctor to see if there's another treatment you can try.

Will I gain or lose weight?

Fluoxetine can make you feel less hungry than usual, so you may lose weight when you start taking it.

If you start to have problems with your weight while taking fluoxetine, talk to your doctor or pharmacist.

Will it affect my contraception?

Fluoxetine does not affect any type of contraception including the combined pill or emergency contraception.

But if you have severe diarrhoea for more than 24 hours, your contraceptive pills may not protect you from pregnancy. Check the pill packet to find out what to do.

Read what to do if you're on the pill and you have diarrhoea.

Can I drive or ride a bike?

Some people cannot concentrate properly while they're taking fluoxetine. It might be best to stop driving and cycling for the first few days of treatment until you know how this medicine makes you feel.

It's an offence to drive a car if your ability to drive safely is affected. It's your responsibility to decide if it's safe to drive. If you're in any doubt, do not drive.

Talk to your doctor or pharmacist if you're unsure whether it's safe for you to drive while taking fluoxetine. GOV.UK has more information on the law on drugs and driving.

Can I drink alcohol while taking fluoxetine?

You can drink alcohol while taking fluoxetine but it may make you feel sleepy. It might be best to stop drinking alcohol for the first few days of treatment until you see how the medicine affects you.

Is there any food or drink I need to avoid?

You can eat and drink normally while taking fluoxetine.

Will recreational drugs affect it?

Using cannabis while you’re taking fluoxetine can give you a fast heartbeat. If it makes you feel drowsy, cannabis can also make this worse.

Methadone can increase the risk of side effects in people taking fluoxetine.

It can also be dangerous to take fluoxetine with:

stimulants like ecstasy (MDMA) or cocaine
hallucinogens like LSD
novel psychoactive substances (which used to be known as legal highs) like mephedrone

Fluoxetine has not been properly tested with recreational drugs. Talk to your doctor if you think you might use recreational drugs while taking fluoxetine.

Find out more about some of the side effects of recreational drugs on the Frank website.

Page last reviewed: 10 February 2022
Next review due: 10 February 2025

How Long Does it Take for Prozac to Work?

Prozac is a commonly prescribed antidepressant medication.

It is approved by the U.S. Food and Drug Administration (FDA) to treat symptoms of depression, and is also used to treat anxiety.

Depression impacts 280 million people around the world, according to the World Health Organization (WHO).

If you are considering an antidepressant, it’s natural to wonder how long it might take to help you feel better.

In this article, I’ll explain how Prozac works, and how long it takes to start taking effect.

I’ll also outline some of the medication’s side effects, what you should know before taking it, and who should not take Prozac.

I’ll also talk about how to know when you are feeling better, and when to talk to your doctor.

How Long Does it Take for Prozac to Work?

Prozac helps the brain increase its levels of serotonin, a brain chemical that helps to balance mood.

Prozac does not have a rapid or immediate effect on mood, but once it does achieve consistent levels in the body, it is a highly effective medication.

Many patients see some improvement on Prozac right away, but most people notice the antidepressant effects after 2-4 weeks of daily use.

Prozac has a longer half-life than many other antidepressants at 2-4 days, which means it remains in your body longer than some other medications.

The half-life is the amount of time it takes for a medication to decrease in your body by 50%.

This long half-life makes it easier to stop Prozac than some other antidepressants, which can cause withdrawal symptoms when you stop them abruptly.

The metabolite, or substance, that Prozac is broken down into has an even longer half-life of 7-9 days, which means it may stay in your system for a few weeks after you stop taking it.

Have questions about a Prozac prescription? Chat with a doctor today.

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Prozac Side Effects

Prozac may cause some common side effects, including:

Mood changes: While Prozac is often used to treat anxiety and is approved by the Food and Drug Administration (FDA) for the treatment of panic disorder, some patients may experience nervousness or anxious feelings when they start taking it. These usually subside as your body adjusts to the medication. Always let your healthcare provider know if side effects are concerning.

Sleep changes: Problems falling or staying asleep, or fatigue.

Gastrointestinal symptoms: The most common side effects of Prozac include nausea, diarrhea, and heartburn. Loss of appetite is possible, but is not as common. If you lose your appetite or struggle to eat while taking Prozac, especially if you are younger than 25, tell your provider.

Oral symptoms: Dry mouth is a common antidepressant symptom, as is yawning. Both can be common with Prozac, or with the generic version, fluoxetine.

Changes in sex drive or sexual ability: People with penises may experience ejaculation problems, whereas people with vaginas are more likely to experience decreased libido.

What Conditions Does Prozac Help With?

Prozac (fluoxetine) is approved by the FDA for the treatment of the following:

Major depressive disorder (MDD) (also known as clinical depression)
Obsessive-compulsive disorder (OCD)
Panic disorder
Bulimia
Binge eating disorder
Premenstrual dysphoric disorder (PMDD)
Bipolar disorder (along with olanzapine)
Treatment-resistant depression (along with olanzapine)

Doctors may also use Prozac for off-label purposes. “Off-label” means that the medication has not been approved by the FDA for the condition the doctor is prescribing it for, but the doctor can provide justification for why the medication can help manage symptoms.

Some common off-label uses of Prozac include:

Social anxiety disorder (also known as social phobia)
Post-traumatic stress disorder (PTSD)
Borderline personality disorder
Raynaud phenomenon
Selective mutism
Generalized anxiety disorder

Prozac is a selective serotonin reuptake inhibitor, or SSRI. Serotonin is a neurotransmitter, a chemical used by the nervous system to transmit messages in the body and brain.

Usually, when it’s finished relaying the message, the brain clears, or “reuptakes,” serotonin.

Prozac and other SSRIs work by blocking the clearance of serotonin from the brain.

Because of this increase in the brain’s access to this important neurotransmitter, Prozac can help stabilize mood, support feelings of calm, improve the perception of well-being, and increase feelings of positivity.

What to Know Before Taking Prozac

Prozac may cause serious interactions with other medications.

If you take any of the following, tell your doctor before starting Prozac:

MAOIs (monoamine oxidase inhibitors)
TCAs (tricyclic antidepressants)
Benzodiazepines
Antipsychotics
Anticonvulsants
Serotonergic drugs
Anticoagulant drugs
NSAIDs
Aspirin
Olanzapine
Thioridazine
Pimozide

This is not a complete list of potential interactions.

Prozac should not be consumed with alcohol, marijuana, CBD, or any illicit drugs, since they can have serious interactions and change the way that the brain responds to serotonin.

Tell your doctor about everything you take, including other medications, supplements, vitamins, and illicit drugs.

Who should and should not take Prozac

In addition to medication interactions, Prozac is contraindicated in certain people or may be riskier for certain populations.

People who are pregnant: Prozac should only be used in pregnant people if the benefit outweighs the potential risk. It is a Class C pregnancy drug. There are no studies assessing the safety of Prozac in the first trimester of pregnancy, and it is not fully understood how it impacts labor and delivery. If you become pregnant while taking Prozac, tell your provider right away.

People who are breastfeeding: Prozac is excreted in breastmilk, so nursing people should not take it.

Older adults: Prozac stays in the system longer than other medications. This can lead to higher concentrations of the drug in the body, which may increase the risk for hyponatremia (low sodium levels).

Liver problems: Prozac is processed by the liver. Decreased liver function increases the half-life, leading to higher levels of the drug.

How to Know When You Are Getting Better

Prozac is very effective for the treatment of depression and other psychiatric conditions, but every person responds differently to medications.

It takes an average of 2-4 weeks before your body acclimates to Prozac and before it is circulating effectively in your system.

You may not notice improvements until it has been that long, and as you initially adjust to the medicine, you may notice some side effects that could make things feel worse.

Keep your doctor or provider informed about how you are feeling.

If the dose is right, you should start to feel better within 2-4 weeks, but you may continue to improve over more weeks or even months if you are taking Prozac longer-term.

It often takes a few dose adjustments to find the perfect long-term dose.

How you define getting better may be different from someone else.

To know if you are improving, ask yourself the following questions:

Am I able to function in my daily life better than before I started Prozac (for example, keeping up with household responsibilities, caregiving, self-care, hygiene)?
Am I able to perform better than before I started Prozac in work, school, or other pursuits or interests (for example, are focus and motivation better)?
Am I excited about things that I care about and enjoy more than before I started taking Prozac?
Do I feel more confident socially, emotionally, or in other ways than before I started taking Prozac?

There are many ways to decide if Prozac is working for you and supporting your well-being.

The most important way is if you are feeling better and experiencing an improved quality of life.

When to See a Doctor

If you are worried about depression or another mental health condition, talk to a doctor or mental health professional.

If you experience any concerning side effects or are feeling worse while on Prozac, let your provider know.

If you believe you are experiencing a severe allergic reaction are are having suicidal thoughts, seek emergency medical care or call 9-1-1. You can also get free 24/7 support from a suicide and crisis expert by calling or texting 988. If you’d prefer to chat online, you can chat with a suicide and crisis expert by visiting the Lifeline Chat.

If you have been taking Prozac for 4 weeks but you are not feeling better, let your prescriber know.

You may need a higher dose, or Prozac may not be an effective drug for you.

If your provider does switch your medication, you may need to taper or wean off of Prozac before starting something else.

Be sure to follow your healthcare provider’s instructions carefully.

Never stop taking Prozac or any other antidepressant suddenly without your doctor’s guidance.

Have questions about a Prozac prescription? Chat with a doctor today.

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How K Health Can Help

Think you might need a prescription for Prozac (fluoxetine)?

K Health has clinicians standing by 24/7 to evaluate your symptoms and determine if Prozac is right for you.

Get started with our free assessment, which will tell you in minutes if treatment could be a good fit. If yes, we’ll connect you right to a clinician who can prescribe medication and have it shipped right to your door.

Frequently Asked Questions

What does Prozac feel like when it starts working?

Initially, Prozac may lead to some gastrointestinal symptoms or other side effects that may make you question your decision to take it. However, as your body adjusts to the medication, these symptoms should lessen. As your body reaches higher levels of the medication, typically over 2-4 weeks, Prozac may help your mood feel lighter, and you may feel calmer, happier, less anxious, more relaxed, or more able to function normally.

What is the peak time for Prozac?

Peak plasma concentration of Prozac occurs 6-8 hours after taking the drug. It works best when taken every day for 2-4 weeks. Prozac has a long half-life of 2-4 days, meaning that it takes that long for the dose in your body to be reduced by half. As Prozac is broken down, the resulting substances, called metabolites, stay in your system even longer—at least 7-9 days before half of these substances are gone.

K Health articles are all written and reviewed by MDs, PhDs, NPs, or PharmDs and are for informational purposes only. This information does not constitute and should not be relied on for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment.

K Health has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references.

Depression. (2021).
https://www.who.int/news-room/fact-sheets/detail/depression
Fluoxetine. (2021).
https://www.ncbi.nlm.nih.gov/books/NBK459223/
Fluoxetine. (2022).
https://medlineplus.gov/druginfo/meds/a689006.html
Label for Prozac (fluoxetine). (2017).
https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/018936s108lbl.pdf

How Prozac Made the World Love Depression — Bird In Flight

At the end of the 20th century, Prozac helped humanity cope with one of the most difficult diseases of our time — depression. But at the same time, he created a cult out of the disease. Bird in Flight tells the story of the rise and fall of the happiness pill.

The diagnosis of "clinical depression" began a century and a half ago, today it is already the second most common in the world. This disorder affects about 300 million people. One in six people with severe depression is at risk of committing suicide. Despite the complexity of the disease, it is now not considered incurable, and for this we should be grateful to Prozac, a drug that has changed the idea of depression.

An incurable disease

For a long time, medicine did not know how to help people with depression: in the Middle Ages, it was treated with prayers, in the Renaissance, with vegetarianism. Only in the 19th century did doctors realize that the main cause of depression was a malfunction in the nervous system. Patients were prescribed stimulant psychoactive substances such as alcohol, opium, cocaine, and eventually sedative barbiturates. They did not cure the disease, but only temporarily relieved the symptoms, while causing addiction.

Accidental discovery

A breakthrough in the fight against depression occurred in the early 1950s, when a drug for tuberculosis, iprovizid, was being studied in the United States. The medicine coped with its task poorly, but it was found to have an unusual side effect: after taking it, appetite returned to tuberculosis patients, their mood improved. As the doctors recalled, "the patients danced despite the holes in their lungs. " Psychiatrists who undertook to study iprovisid confirmed its psychoactive properties. Thus, a new class of drugs appeared - antidepressants.

The first such drugs were very toxic and had many side effects. Patients taking them suffered from heart problems, excess weight and slow reflexes. However, the medications did not help everyone.

The first antidepressants had many side effects. Patients taking them suffered from heart problems, excess weight and slow reflexes.

In the early 1970s, a number of pharmaceutical companies began to develop a new generation of depression drugs that would not have these unpleasant side effects. Its discoverer was David T. Wong, a researcher at the American pharmaceutical company Eli Lilly. For a long time, Wong studied the mechanisms of reuptake of serotonin, a neurotransmitter responsible, among other things, for the emotional background of a person. The researcher's task was to find a substance that would prevent the absorption of serotonin by brain neurons. It was opened at 1972, the substance was named fluoxetine.

Unlike the older antidepressants, which, like weapons of mass destruction, acted on all neurotransmitters at once, fluoxetine worked selectively. Patients could no longer be afraid of lethargy; the problem of side effects seemed to be solved.

"Prozac: wash away your blues!" Source: Tumblr / Adbusters

Killer marketing

Another advantage of the new drug was that, in addition to reuptake, it also blocked the uptake of norepinephrine, that is, it acted as a stimulant on the nervous system. So Eli Lilly made the right decision to sell fluoxetine not as an antidepressant but as a mood booster. The company wanted customers not to think about taking the medicine. Fluoxetine was supposed to be associated with energy and vivacity, so the first step in its promotion was a name change. This task was entrusted to Interbrand, whose clients included Sony, Microsoft and Nintendo. Thanks to her, fluoxetine became Prozac.

Eli Lilly introduced the drug to the US Food and Drug Administration in the late 1970s. Consideration of the application stretched for ten years. Department officials were embarrassed that Prozac had a stimulant rather than a sedative property. Despite this, it was still approved, and in December 1987 the drug entered the market.

Cult of Sorrow and Joy

In its first year, Prozac sold $350 million in the US and $2.6 billion worldwide. The drug finally convinced humanity that depression is not a sentence, as previously thought, and happiness is not an abstract concept, but a state that can be achieved with the help of pills.

"Prozac" finally convinced humanity that depression is not a sentence, as previously thought, and happiness can be achieved with the help of pills.

The popularity of the medicine was also supported by media attention. So, on December 18, 1989, New York Magazine came out with Prozac pills on the cover. The headline was "Buy-Buy Blues." After that, almost all the major magazines of that time wrote about the pills.

Eli Lilly's marketing idea worked. The Americans perceived the drug as an energy drink, after drinking which one could become more productive. It seemed that the whole country fell in love with the medicine, including doctors. At 19In 1993, psychiatrist Peter Kramer published Listening to Prozac, which became a New York Times bestseller. In it, the author suggested that the drug not only allows you to cope with depression, but also can make a mediocre person more bright, a shy person more open and sociable, and an ambitious employee can help climb the career ladder. After the publication of the book, sales of the pills increased another 15%.

Shot from the movie Prozac Nation (2001) / Miramax / Album

The peak of Prozac's popularity came in the 90s - comedians and writers started talking about the drug. “When do the holidays start in New York? When drug dealers start selling more Prozac than crack" - this joke was made on the evening show with David Letterman in 1994. In the same year, writer Elisabeth Wurzel published Prozac Nation, a book about her experience of dealing with clinical depression. Wurzel's work is considered one of the examples of the romanticization of the image not only of Prozac, but of antidepressants in general.

Prozac has made its way into music as well. In 1996, the rock group Mr. T Experience released the song That Prozac Moment, in which the effect of taking the drug was compared to a moment of fleeting happiness, when you can forget about everything. Also, the drug is mentioned in the compositions of Aerosmith, Pixies, Red Hot Chili Peppers, Neil Diamond, Nick Cave and other artists.

Love no matter what

When INXS lead singer Michael Hutchence took his own life in 1997, the media wrote that Prozac killed the star. The musician's case was one of several dozen suicide cases that swept across the United States, all of which were associated with the use of fluoxetine. Eli Lilly started getting lawsuits. Later it turned out that the company knew that the drug could increase the risk of suicide even at the stage of clinical trials. It was especially dangerous for teenagers.

How could a pill designed to treat depression cause people to commit suicide? It was assumed that suicidal thoughts were in patients who committed suicide even before the start of the drug, but due to depression they lacked the strength to realize their plans. Prozac just became a source of energy. Defenders of the drug argued that it was not the drug that was responsible for the deaths, but the disease. However, according to The Guardian, the drug can cause suicidal thoughts in people who do not suffer from depression.

The fact that the drug can increase the risk of suicide, the company knew even at the stage of clinical trials.

When Eli Lilly's patent for Prozac expired in 2001, fluoxetine-based competitor products filled the market. The side effects of the new generation of antidepressants were even less. However, even today, Prozac, along with them, remains one of the most effective means to combat depression.

The drug scandals have made the medical community and the media more critical of antidepressants—they are no longer considered a panacea. In 2008, a study was published proving that drugs for depression are effective in severe manifestations of the disease, but in the lungs they are barely noticeable than placebo. The approaches of pharmaceutical companies to the promotion of antidepressants on the market were also subject to revision. The Guardian believes that manufacturers often do not publish the results of their research or, even worse, influence them. Often, companies use advertising to change the idea of the disease, convincing the public that even minor sleep disturbances and mood swings are a cause for concern.

However, the global antidepressant market is expected to surpass $18 billion by the end of 2024, with fluoxetine accounting for a significant portion of the profits. What makes these drugs so popular?

As Vladislav Dorofeev writes in his book "Great Medicines", this is a person's desire to get a simple and universal remedy for anxiety and loneliness. Modern people do not have time to delve into themselves.

Photo: Stephen Chernin / Getty Images North America / Getty Images via AFP

How we are treated: Prozac. From depression to bulimia

Medicine

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.

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).

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).

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.

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.

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: https://clck.ru/Pnmtk

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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But all these are only 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.

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.

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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.

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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.

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.

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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.

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.

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.

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.

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