Prozac cause anxiety
Prozac for Anxiety: Is It Effective?
Occasional anxiety is common and happens to all of us, but anxiety disorders are more than brief anxiety.
People with anxiety disorders deal with excessive fear and worry that interferes with daily life, with these feelings lasting longer than 6 months.
According to the Anxiety and Depression Association of America (ADAA), anxiety disorders affect over 40 million American adults, though a majority of people don’t receive treatment.
There are several treatment options available to manage symptoms of anxiety disorders, including psychotherapy and medications like Prozac.
In this article, we’ll discuss Prozac’s use in anxiety, side effects, risks, and other key information.
Prozac (fluoxetine) is a popular antidepressant medication that’s been around since the 1980s. It is approved to treat panic disorders — a type of anxiety disorder, but doctors also often prescribe Prozac to treat other types of anxiety as well.
Prozac is a brand-name medication that is also available in generic versions in different strengths. Generic versions are generally less expensive than brand-name Prozac.
It’s approved by the Food and Drug Administration (FDA) to treat major depressive disorder, obsessive compulsive disorder (OCD), bulimia, and panic disorder, but doctors also prescribe Prozac off-label to manage other types of anxiety disorders.
Prozac and other medications in this class — known as selective serotonin reuptake inhibitors (SSRIs) — are considered the first choice for treatment of anxiety disorders.
Prozac and other SSRI medications are preferred by doctors over other medications like alprazolam or diazepam because they’re not habit-forming and can be used long term to treat symptoms of anxiety.
Prozac is also generally thought to be safer than older antidepressants like tricyclic antidepressants or MAO inhibitors which are also used to treat anxiety symptoms.
What the science says
According to the U.
S. National Library of Medicine, clinical studies of Prozac show it to be effective in managing symptoms of certain anxiety disorders like panic disorder.
There aren’t, however, a lot of studies that show Prozac’s effectiveness for generalized anxiety disorder, or how it compares with other medications approved to treat symptoms of anxiety disorders.
Other SSRI medications such as Lexapro (escitalopram) and Paxil (paroxetine) have shown effectiveness and are approved to treat GAD and other anxiety disorders.
Studies also show that cognitive behavioral therapy (CBT), when used along with antidepressants to manage symptoms of generalized anxiety disorder, can help people stay with their medication treatment and improve symptoms long-term.
Advantages of Prozac for anxiety
- oral medication with convenient, once-daily dosing
- generic available making it affordable
- not habit-forming like benzodiazepine medications for anxiety
Disadvantages of Prozac for anxiety
- has an FDA black box warning for suicidal thoughts and behavior
- not approved for generalized anxiety disorder
- may cause anxiety, trouble sleeping, and nervousness
Prozac belongs to a class of medications called SSRIs.
While the exact way SSRIs work isn’t known, one of the ways it’s thought to work is by regulating mood by increasing serotonin in your brain.
This is one of the reasons doctors often prescribe SSRIs like Prozac to ease symptoms of mood-related conditions like anxiety.
Prozac and other antidepressant-type medications can also be effective when someone has other mental health conditions, like depression, along with anxiety.
Prozac and generic fluoxetine are available in several different strengths and dosage forms (capsule, tablet, liquid) for ease of dosing.
The dosage for Prozac depends on
- the condition being treated
- your age
- your health
- other medications you may be taking
For panic disorder, the usual starting dose is 10mg per day and may be increased if needed. Your doctor will decide the best dose of Prozac for you based on your condition and how you respond to treatment.
Take Prozac exactly as prescribed. Keep in mind, it may take several weeks to see the full effects of Prozac.
Do not suddenly stop taking Prozac, you could experience withdrawal symptoms.
Prozac can be taken with or without food.
Ask your doctor or pharmacist about the best way to take Prozac and how to manage side effects.
Prozac may cause side effects, and some may be serious. This isn’t a complete list of all side effects of Prozac. Ask your pharmacist or doctor for a full list of side effects.
Side effects generally go away after a few days or a few weeks, but if they’re bothersome or serious, call your doctor to discuss your treatment options.
Prozac can also cause anxiety as a side effect. This may happen when you first start taking Prozac. Ask your doctor what to expect with Prozac.
Common side effects
Some common side effects include:
- anxiety, nervousness
- headache
- nausea
- diarrhea
- dry mouth
- indigestion
- trouble sleeping
Serious side effects
Serious side effects include:
- serotonin syndrome (too much serotonin builds up and can be dangerous)
- allergic reactions
- unusual bruising or bleeding
- mania symptoms (intense mood shifts)
- seizures
- low salt levels in the blood (symptoms include headache, confusion, weakness)
If you experience a severe or life-threatening reaction to Prozac, call 911 right away.
Prozac can interact with other medications (including over-the-counter products), vitamins, herbs, and other supplements. Be sure to tell your doctor and pharmacist about all of the medications and OTC products you take.
Ask your doctor for more information, but you should avoid taking these medications with Prozac:
- MAO inhibitors (MAOIs), when taken with Prozac, can cause dangerous reactions, including high fever, changes in blood pressure, heart rate, confusion, and loss of consciousness.
- Thioridazine can increase heart rhythm problems.
- Pimozide can increase heart rhythm problems taken with Prozac.
Other medications that may interact with Prozac and increase side effects include:
- other antidepressant medications
- central nervous system depressant medications (opioids, benzodiazepines)
- lithium
- St. John’s wort
- amphetamines
- warfarin
- aspirin
- NSAIDs (ibuprofen, acetaminophen)
- anticonvulsant medications (carbamazepine, phenytoin)
This isn’t a complete list of all the interactions with Prozac.
Ask your pharmacist for a complete list of interactions.
Prozac has a black box warning. This is the most serious warning about a medication from the FDA.
People with major depressive disorder (MDD) may experience worsening of their depression, suicidal thoughts, or behavior. The risk is higher for children and adolescents under age 25.
Share your medical and family history with your doctor and ask about the risks of Prozac. Your doctor will monitor you carefully while you take Prozac.
Prozac may cause loss of appetite and weight loss. This may be serious in some people. Your doctor will need to monitor your weight while you’re taking Prozac.
Read this for a list of other medications used to treat anxiety and helpful information about each.
What is anxiety?
Anxiety is a normal reaction to stressful situations and is common. Anxiety disorders are a more extreme, long-lasting type of anxiety. Scientists don’t know exactly what causes anxiety disorders, but genetic and environmental factors may play a role.
Anxiety disorders can also be accompanied by other mental health conditions such as depression.
Symptoms can include:
- nervousness
- muscle tension
- feelings of panic, dread, or danger
- trouble falling asleep
- increased heart rate
- fast breathing
- restlessness
- diarrhea or constipation
- difficulty concentrating
It’s important to speak to a mental health professional to understand your anxiety symptoms and develop management goals. This may include medication and psychotherapy.
Yes, it’s possible to overdose on Prozac. Always take the medication exactly as your doctor has prescribed. Taking too much Prozac can be dangerous and even life-threatening.
If you think you’ve taken too much Prozac, call 911 (or your local emergency number) or go to an emergency room to get help right away.
Symptoms of overdose can include:
- agitation
- confusion
- dizziness
- high blood pressure
- fast heart rate
- nervousness
- trouble walking
- seizures
- nausea, vomiting
- tiredness
- tremors
Allergic reactions to Prozac
Prozac can cause allergic reactions in some people.
Avoid Prozac if you’re allergic to any of the ingredients of Prozac. Symptoms of an allergic reaction can include swelling of skin, rash, itching, or trouble breathing or swallowing.
Don’t suddenly stop taking Prozac without talking to your doctor.
You may experience withdrawal symptoms including
- confusion
- dizziness
- insomnia (trouble sleeping)
- irritability
- nightmares
Alcohol may worsen symptoms of anxiety and increase some side effects of Prozac. Ask your doctor if it’s safe to drink alcohol with Prozac.
Prozac may not be safe for you if you have certain health or medical conditions. Ask your doctor for more information about the risks and benefits of Prozac for you.
- Liver disease. If you have problems with your liver, your doctor may need to adjust your dose of Prozac or consider other medications to manage your anxiety.
- Seizures. If you have a history of seizure disorder, your doctor will discuss your risks if you choose to take Prozac.
- Bipolar 1 disorder. Prozac can increase the risk of manic episodes when used alone in people with bipolar disorder.
- Blood clotting disorders. If you’re taking medications like warfarin to thin your blood, Prozac can increase your risk of bleeding.
- Pregnant or breastfeeding. It isn’t known if Prozac is safe during pregnancy or while breastfeeding. Ask your doctor about the benefits and risks of Prozac if you’re pregnant or breastfeeding.
Anxiety disorders are complex, chronic conditions that can be long-lasting with many causes. But there are lots of treatment options available including medications and psychotherapy like cognitive behavioral therapy (CBT) that can help regulate symptoms.
Prozac is a well-known antidepressant that’s currently only approved to treat panic disorder. Talk to your doctor about the benefits versus risks of Prozac and other options to manage anxiety symptoms.
Ask your healthcare provider for more information about Prozac and if it’s the best medication for you.
Be sure to discuss your health and medical history to help your doctor find the best treatment course.
Learn about anxiety triggers and consider these positive steps to help manage anxiety
- regular exercise
- focused breathing techniques
- proper sleep
- stress management skills
If you’ve recently started taking Prozac, remember it can take time to work. Don’t stop taking Prozac without talking to your doctor to avoid unpleasant side effects like withdrawal.
How do antidepressants trigger fear and anxiety? Researchers map the anxiety circuit in the brain and use a compound to limit fearful behavior -- an acute side effect of commonly prescribed SSRI antidepressants -- ScienceDaily
More than 100 million people worldwide take selective serotonin reuptake inhibitors (SSRIs), such as Prozac and Zoloft, to treat depression, anxiety and related conditions, but these drugs have a common and mysterious side effect: they can worsen anxiety in the first few weeks of use, which leads many patients to stop treatment.
Scientists at the University of North Carolina (UNC) School of Medicine have mapped out a serotonin-driven anxiety circuit that may explain this side effect and lead to treatments to eliminate it.
"The hope is that we'll be able to identify a drug that inhibits this circuit and that people could take for just the first few weeks of SSRI use to get over that hump," said senior investigator Thomas L. Kash, PhD, the John Andrews Distinguished Professor of Alcohol Studies in the UNC School of Medicine's department of pharmacology. "More generally, this finding gives us a deeper understanding of the brain networks that drive anxiety and fear behavior in mammals."
The new study, published in Nature, counters the popular view of serotonin as a neurotransmitter that promotes only good feelings. SSRIs, which are taken by about one in 10 people in the United States and about one in four women in their 40s and 50s, are thought to improve mood by boosting serotonin activity in the brain.
There are brain circuits through which serotonin does seem to improve mood, and some studies have linked depression to abnormally low levels of serotonin. But the short-lived promotion of anxiety in many patients on SSRIs -- even suicidal thinking, particularly in younger people -- has long hinted that serotonin can have negative effects on mood, depending on the precise brain circuit where it acts.
In the Nature study, for which co-authors were UNC postdoctoral researcher Catherine A. Marcinkiewcz, PhD, and UNC graduate student Christopher M. Mazzone, the researchers used an array of sophisticated methods, including advanced optogenetic and chemogenetic tools, to trace a serotonin-activated pathway in the brains of mice, a pathway that drives anxious behavior.
The team first demonstrated that a mild shock to the paws of mice -- a standard method for evoking fear and anxiety behaviors -- activates serotonin-producing neurons in the dorsal raphe nucleus (DRN), a brainstem region known to be involved in mood and depression.
These DRN serotonin neurons project to a brain region that is called the bed nucleus of the stria terminalis (BNST) and has been shown in previous studies to have a role in serotonin's negative mood effects in rodents. Artificially increasing the activity of the DRN-to-BNST neurons enhanced anxiety-like behaviors in the mice.
UNC scientists found that the serotonin output from the DRN neurons activates their target neurons in the BNST through a specific subset of serotonin receptors, known as 2C receptors. These serotonin-activated BNST neurons then tamp down the activity of another family of BNST neurons, which, in turn, project to the ventral tegmental area (VTA) and lateral hypothalamus (LH) -- key nodes in the brain's reward, motivation and alertness networks.
The pathways from BNST to VTA and LH have been reported in previous studies to improve mood and relieve anxiety. Researchers confirmed that artificially driving the activity of these pathways has the effect of reducing foot-shock-induced fear and anxiety behaviors in the mice.
By contrast, the silencing of these pathways by serotonin-activated BNST neurons effectively allows the anxiety level to rise.
Examining the impact of SSRIs, the scientists exposed 2C-receptor BNST neurons to fluoxetine (Prozac), which like other SSRIs gives a boost to serotonin levels wherever the neurotransmitter is at work. This turned out to increase the 2C-receptor neurons' inhibitory effect on the neighboring VTA- and LH-projecting neurons, worsening fear and anxiety behavior in mice.
How can this effect be blocked? Kash and his team observed that the anxiety-mediating BNST neurons expressed the stress-signaling molecule corticotropin releasing factor (CRF). When they added a compound to block CRF activity, they witnessed that fearful behaviors -- which had been triggered by fluoxetine -- were greatly reduced.
One of the next steps is to confirm that this serotonin-sensitive DRN-to-BNST anxiety circuit exists in humans as well. "It's logical that it would," Kash said, "since we know SSRIs can induce anxiety in people, and the pathways in these brain regions tend to be very similar in mice and humans.
"
Another next step will be to test drugs -- ideally FDA-approved for various conditions -- for their ability to alter this anxiety circuit and thereby block SSRIs' anxiety-inducing effect. In principle, a CRF-blocker might work. For years, pharmaceutical companies have been trying to develop CRF blockers to treat depression, anxiety and addiction. In practice, Kash said, CRF blockers haven't yet had success in clinical trials, so an FDA-approved one is probably still years away at least.
"Other researchers are working to develop better CRF-inhibiting compounds, so that's one potential direction to take, but there are others," Kash said. "We're now looking at the various proteins expressed by these BNST neurons, and we're hoping to identify a receptor that is already targeted by established drugs. One of them might be useful for people as they start taking SSRIs."
What they treat us with: 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.
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.
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.
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.
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.
If you notice allergic reactions or nausea and headache, you need to see a doctor and ask if you should stop taking the medicine.
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
What you should know about antidepressants
Ekaterina Kushnir
treats anxiety disorder
I have generalized anxiety disorder.
For a long time I coped without pills and other help, but one day I got tired of constant anxiety and began to interfere with my normal life. As a result, I turned to a private psychiatrist.
The doctor prescribed an antidepressant from the SSRI group - these are selective serotonin reuptake inhibitors. Such drugs are the first thing prescribed in the treatment of depression and a number of other conditions, including my disease.
The doctor immediately warned me about some peculiarities associated with taking the drug. Some of them I then felt on myself. I think everyone who plans to be treated with antidepressants should know about them.
At the same time, it should be taken into account that most of the negative effects of therapy are temporary and not dangerous, and if they do not go away, one medicine can be replaced with another. Antidepressants help many people with mental disorders and other illnesses get rid of their symptoms and return to a full life, so you definitely should not be afraid of them. The main thing is to take such drugs when they are really needed: as prescribed by a competent doctor and under his control.
Go see a doctor
Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don't write prescriptions, we make recommendations.
Relying on our point of view or not is up to you.
Fact No. 1
Antidepressants may make symptoms worse at firstAntidepressants can increase anxiety in anxiety disorders, as well as cause irritability and agitation - the so-called causeless motor agitation, the inability to sit still. It's not dangerous, but rather unpleasant. This condition is sometimes referred to as initial anxiety, that is, the anxiety of starting therapy. Up to 65% of people face it.
Antidepressant-induced anxiety syndrome - a systematic review in the British Journal of Psychiatry
There is also evidence that some classes of antidepressants, including SSRIs, may increase suicidal ideation in depression in young people aged 18 to 24 years. These data are not very reliable, and in older people, the risk of suicide no longer increases and even decreases.
Without treatment, depression is more likely to lead to suicidal thoughts, and in case of anxiety, you just need to prepare for such an effect, then it will be easier to survive the attacks.
The doctor told me that in the first two or three weeks there may be an increase in anxiety, but I did not take it too seriously.
Everything was fine for the first week. After about seven days, I became nervous and irritable. And then I woke up at night and after a while I felt an incomprehensible fear. My heartbeat increased, my head was spinning, my throat was constricted. Because of this, I felt a real panic - I spent the rest of the night fighting terrible thoughts, in the morning I got up completely broken.
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I have never had such panic attacks before medication - my anxiety was background, general. I got scared and wrote to the doctor, who reassured me and said that it was not dangerous and would pass soon.
After that, I already expected these panic attacks, immediately tried to relax, calm down, remember that this was just a temporary effect of the drugs.
And they ended faster, and then they completely disappeared.
Fact No. 2
The effect of antidepressant treatment will not be immediateIncrease the dose of antidepressants gradually to reduce side effects. They usually start with the minimum, and then bring it up to the working one. For example, for SSRIs with the active ingredient "sertraline", the working dose is from 100 mg per day. I started taking such a drug with 25 mg, and then gradually, in several steps, under the supervision of a doctor, raised the dose to 100 mg.
SSRI dosage - NHS
What doses of antidepressants will be optimal - an article in The Lancet
The process of reaching a working dose can take from two weeks to a month or more. It depends on the drug and its tolerance. I turned out to be sensitive to the medicine, it was hard for me to survive every increase in dosage: anxiety increased again, there were other side effects that then stopped.
However, this is not the case for everyone, sometimes the process goes faster.
The full therapeutic effect, that is, the disappearance or a strong improvement in the symptoms of the disease, occurs some time after reaching the working dosage. As a rule, this is a week or two, although some positive changes may be earlier. For some people, this process stretches for a longer period: 6-12 weeks. Minimum initial doses of drugs usually do not work.
It is better to prepare for the fact that the symptoms of the disease will not disappear in the first weeks of treatment. And remember - this does not always mean that the drug needs to be changed, sometimes you just need to wait or further increase the dosage under the supervision of a doctor.
Fact No. 3
Antidepressants are usually taken in combination with other drugs Another way to mitigate the side effects of antidepressants is to prescribe an additional drug along with them: for example, from the group of tranquilizers.
Such drugs may have their own side effects, they should not be taken for a long time. Unlike antidepressants, some of them can be addictive. They are usually appointed for a month, but this period may be shorter or longer.
Antidepressants together with benzodiazepines work better for depression - BMJ magazine
My doctor prescribed a rather mild drug for me. However, he did not suit me. At first, it caused increased drowsiness: during the period of increased anxiety, it went away for a while, but then returned - even with half a pill I turned off and could sleep all day. And if I drank at night, I woke up with difficulty in the morning. The psychiatrist prescribed another medicine, but I could not buy it: the drug was not available in any pharmacy nearby.
As a result, I simply endured all the side effects of therapy - they were unpleasant, but tolerable. When discussing with the doctor, she called this option acceptable if the side effects of the second medicine only worsen the situation.
Fact No. 4
Side effects are not always, but they areModern antidepressants, including SSRIs, are mild and have almost no side effects. Older drugs - tricyclic antidepressants and monoamine oxidase inhibitors - cause more side effects. Doctors usually use them when milder first-line drugs don't work or when they can't be prescribed.
Side effects of antidepressants - the National Health Service of the UK
Side effects of various antidepressants - Uptodate
Side effects of antidepressants and their impact on the treatment of a large depressive disorder - the journal NATURE
STRICTIC STRICTIC OF REDITION
. effects of antidepressants - advice from the Mayo Clinic staff
Choosing an SSRI drug does not guarantee the absence of side effects - many people tolerate treatment easily, but sometimes a change in drug may be necessary.
The first couple of weeks of taking there is a risk that the state of health will be so-so - it's worth thinking about.
It may be worth scheduling the start of therapy on vacation.
I work remotely, and it was easier for me: the first pill was taken on Saturday, I slept through the weekend. Then she continued to work, but refused any additional loads: housework, part-time jobs, training and everything else.
It was hard work: I wanted to sleep, then I began to worry and get distracted. I also had diarrhea, nausea, headaches, tremors, i.e. hand trembling, hot flashes, sweating, palpitations. At night, panic attacks began, in the morning I had difficulty getting up because I was in pain and dizzy.
There are mixed data on how common the side effects of antidepressants are. If we summarize them, then the numbers look something like this:
- nausea - about 25% feel it;
- diarrhea - it happens in 15% of people, and 5%, on the contrary, will have constipation;
- about 20% of people experience sweating and feeling hot;
- sexual dysfunction, decreased libido may occur in 80% of cases;
- insomnia - in 11% of cases;
- headache and dizziness - in about 10-11% of cases;
- weight gain - not all drugs give this effect.
Some, on the contrary, can reduce weight. On my medicine, I lost 2 kilograms in the first month, despite the fact that I quit training due to poor health. True, then they returned back.
It can be seen that most side effects occur in less than half of the cases. In addition, in most cases they pass in the first weeks and are not dangerous.
Side effects not listed above are very rare. I was "lucky", and I faced one such - a decrease in visual acuity. Once in the morning I noticed that I see worse without glasses. A little later, I realized that something was wrong with the glasses.
I wrote to the doctor, she replied that this happens, as a rule, is not dangerous and passes, but it is better to visit an ophthalmologist. I went to the ophthalmologist, everything was fine with my eyes, there was nothing terrible, but my vision really worsened - it was not a subjective feeling. On the right eye, it was -0.5 diopters, it became -0.75, and on the left eye it was -1.
5, and it became -3.5.
I was offered to try changing the drug, but I decided to wait. Vision was then restored. I have not yet gone to the doctor to have it measured, but according to subjective feelings, it is at the same level as before: I am comfortable again in my glasses.
Side effects should not be tolerated - if something greatly worries, scares or interferes with life, it is better to tell the doctor right away. The psychiatrist will be able to determine whether the side effect of the drug is dangerous and whether it is worth continuing to take it. There are several antidepressants of the SSRI group, in addition, there are groups of drugs with a slightly different mechanism of action. As a rule, doctors manage to find a medicine that gives a good effect without side effects.
If there is no danger, the doctor can adjust the dose or increase it more gradually - this often helps to cope with unpleasant effects.
I wrote to the doctor again when my visual acuity decreased Fact No.
5
Antidepressants are not drugs that you can stop drinking as soon as you get better. They are taken for a long time: usually from several months, less often several years.
Anxiety Therapy - UpToDate
For example, for generalized anxiety disorder, the duration of treatment is at least a year. Moreover, the date is not counted from the very beginning, but from the moment when a lasting effect appeared from the pills. In fact, they will have to be drunk for about 1.5 years - it depends on how long it takes to reach the working dosage of the medicine.
The cost of a package of the most famous antidepressant "Zoloft" is about 700 R, enough for about a month. That is, a course of therapy will cost about 10,000 R - maybe more or less, depending on which drug is selected.
Psychotherapy review - UpToDate
Another drug of the same group already costs more than 2000 R per pack. Source: rigla.ru The cost of an appointment with a good psychiatrist in Moscow is 3000-5000 R.
At first, you will need to visit him about once every 1-1.5 months, then less often.
You can apply to the psycho-neurological dispensary at the place of residence under compulsory medical insurance - it's free. At the same time, they will not put you on psychiatric registration: it was canceled in 1993. People with disorders that do not threaten their lives or those around them are on consultative and diagnostic care. If you stop going to the doctor, he will not find out what happened: a person seeks help at will.
Psychotherapy, usually cognitive-behavioral, is also commonly prescribed to enhance and sustain the effects of antidepressants. In many cases, it improves the effectiveness of drugs, including depression and generalized anxiety disorder. An appointment with a psychotherapist in Moscow costs an average of 5000 R. For treatment, you will need about 10 sessions or more.
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Fact No.
6
Antidepressants are not addictive. However, if you abruptly stop drinking them, there will be a withdrawal syndrome. This is felt as electric current discharges while moving or turning the head, headaches, dizziness, insomnia. Many people experience symptoms similar to the flu or an intestinal virus: low fever, diarrhea, general malaise, chills. Often there is anxiety, there are intrusive images.
Withdrawal symptoms after taking serotonin reuptake inhibitors - Journal of Clinical Psychiatry
How hard it is to stop taking antidepressants - American Psychological Association
Stopping antidepressants in adults - UpToDate
treatment, they should be canceled only under the supervision of a doctor.
Antidepressant withdrawal occurs as gradually as the start of treatment. The dosage is slowly reduced, usually at this time again a cover-up drug is prescribed to alleviate side effects.
As a rule, this is the same medicine that was at the beginning of the intake.
Withdrawal is usually harmless and resolves within the first weeks of stopping the drug. Sometimes even within a few days - it still depends on which medicine was prescribed. If severely disturbing symptoms appear during the withdrawal period, you should consult a doctor.
Fact No. 7
If you need to change the drug, everything will start overIt is far from always possible to immediately find the right antidepressant - sometimes the side effects do not go away and you need to take a new one.
Changing antidepressants in adults - UpToDate
Serotonin syndrome - MSD
Most often, it is started again with a small dosage, this delays the process of obtaining the effect of treatment. The new drug may also have side effects - the same or different. We will have to wait again until they pass.
You won't be able to change the drug on your own, since all antidepressants are sold only by prescription - and that's good.
Switching from one drug to another can be dangerous if you do not know the characteristics of different groups of drugs.
For example, taking SSRIs is possible only some time after the withdrawal of antidepressants from the group of monoamine oxidase inhibitors - due to the risk of developing serotonin syndrome. This is a potentially fatal condition, accompanied by a change in mental state, high fever, increased muscle tone and other symptoms.
If the drug is changed correctly, there will be no dangerous negative effects, so consultation with a doctor is required.
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Fact No. 8
Among antidepressants there are original drugs and generics Preparations may be original or generic. Originals are medicines first released by some pharmaceutical company that have passed all clinical trials and checks. Generics are drugs with the same active ingredient from another pharmaceutical company, that is, copied from the original drug.
Theoretically, the action of generics should not differ from the action of original drugs. However, this is possible, since generics may contain other additional substances or the manufacturer may use other raw materials.
Due to my anxiety, I did not read anything in detail about specific drugs before I bought my first antidepressant in a pharmacy so as not to be scared and not think about taking it. I also didn’t think to ask the doctor about this question.
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As a result, I first bought a generic because it was in stock. Then it turned out that, after all, according to the experience of my psychiatrist, the original drug often gives fewer side effects and is better tolerated. As a result, I changed the generic to the original drug - and, indeed, the side effects softened.
In my subjective opinion, which is supported by some data, in the case of antidepressants and other psychotropic drugs, you should always choose the original medicine.
Moreover, the cost of originals and generics is not always very different.
Originals and generics of some SSRIs
| Active ingredient | Original | Original price | Generics | Cost of generics |
|---|---|---|---|---|
| Sertraline | Zoloft | About 700 R, 100 mg tablets | Serenata, Sirlift | 500-600 R, 100 mg tablets |
| Escitalopram | Cipralex | 3000 R, tablets 10 mg | "Selektra", "Elycea" | 500-1300 R 10 mg tablets |
| Fluoxetine | Prozac | About 350 R, 20 mg tablets | Profluzak, Fluoxetine | 100-200 R, tablets 20 mg |
CERTRALIN
Original
"Zoloft"
Original cost
about 700 r, tablets 100 mg
generics
"Serenata", "Cerelift"
Cost of
9000 500-600 r. , tablets 100 mgEscitalopram
Original
Cipralex
Original price
3000 r, tablets 10 mg
generics
“Checkra”, “Elicea”
The cost of generics
500-1300 r, tablets 10 mg
Flioxetin
Prose “Prose”
Cost Cost Cost cost original
About 350 R, tablets 20 mg
Generics
Profluzak, Fluoxetine
Cost of generics
100—200 R, tablets 20 mg
one remained unclaimed Fact No.
9
Drinking alcohol while taking antidepressants may exacerbate unpleasant side effects. Also, alcohol is a depressant, that is, it has the opposite effect, and its intake can adversely affect the results of treatment.
Why you shouldn't mix antidepressants and alcohol - Mayo Clinic
Alcohol is strictly forbidden to drink with some groups of antidepressants, for example, tricyclic antidepressants and monoamine oxidase inhibitors: combination with the latter, for example, can lead to an uncontrolled increase in pressure. MAO inhibitors in general require a special diet - it is unlikely that a doctor will prescribe such drugs as the first antidepressants, but if necessary, he will issue a list of what is allowed and prohibited.
With other antidepressants, moderate use may not be dangerous and may even pass without consequences, but doctors still recommend abstaining so as not to increase side effects and improve treatment outcome.
The main thing is not to temporarily stop taking the drug in order to drink. This can lead to the development of a withdrawal syndrome.
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Fact No. 10
Antidepressants are incompatible with certain drugs and have contraindicationsIt is important to tell your doctor what medications you are taking and what chronic illnesses you have. For example, SSRIs may not be suitable for epilepsy and bleeding disorders, and tricyclic antidepressants are usually not prescribed for those who have recently had a heart attack, suffer from glaucoma, or porphyria.
Antidepressant Warnings - NHS
Drug Compatibility Test - Drugs.com
It is also important to be careful if you are about to take any over-the-counter medicine. For example, ibuprofen, which people often take on their own to relieve pain and reduce fever. It should not be taken with SSRIs as it increases the risk of gastrointestinal side effects.
