Category Archives: Depression Medication

Prozac: Depression medication of choice?

Prozac Depression Medication: Overview

In addition to depression, Prozac is a medication used to treat bulimia, obsessive compulsive disorder and often symptoms of premenstrual syndrome. Prozac is a depression medication referred to as a selective serotonin reuptake inhibitor (SSRI) which many clinicians and researchers believe increases the level of the neurotransmitter serotonin in the brain. Serotonin is believed to contribute to elevating moods by increasing the level of this neurotransmitter in the brain in such mood disorders as depression. Neurotransmitters are brain chemicals that are discharged by neurons and absorbed by other neurons to complete activities and assist with our moods. Excess neurotransmitter discharged by neurons are reabsorbed back up into the initiating neurons if not absorbed by another neuron. This additional unabsorbed neurotransmitter is believed to enhance moods and reduce depression.

Prozac is most often prescribed to treat depression in the moderate to severe range or what is referred to as major depression, which often has a serious effect on daily activities and functioning. The symptoms of major depression include low energy and low mood, decreased sex drive, feelings of guilt or worthlessness, changes in sleeping habits and appetite, concentration problems, a slowing of the thinking processes and suicidal thoughts and ideation. Prozac is not only taken for major depression however, in may be used for various other mental health disorders such as obsessive-compulsive disorder, and premenstrual dysphoric disorder. Although it is most often prescribed for adolescents, adults and the elderly, it has been prescribed for children at times.

Prozac Depression Medication: Obsessive-compulsive Disorder

Although it is most often used in treating depression, prozac is a medication sometimes prescribed in the treatment of obsessive-compulsive disorder. Obsessions are repetitive thoughts and compulsions are repetitive actions usually performed to reduce anxiety associated with the obsessions. Prozac may also be used to treat eating disorders such as bulimia nervosa, which is a binge eating disorder that involves deliberate vomiting to reduce weight. Prozac is also used at times to treat premenstrual dysphoric disorder

Premenstrual Dysphoric Disorder:

PMDD, which is referred to more commonly as premenstrual syndrome (PMS) which includes mood changes such as depression, anxiety, irritability, persistent anger and mood swings. It is marketed when used for PMDD under the brand name Serafem, which basically has the same active ingredients as the brand name Prozac. The symptoms of PMDD usually begin about 1 to 2 weeks before a woman’s premenstrual period, and includes symptoms such as breast tenderness, headaches, joint and muscle pain and bloating. PMDD can frequently be severe enough to interfere with a woman’s daily activities and relationships and is believed to be helped by this depression medication.

Prozac Depression Medication Precautions:

It is important to always be honest and open with your physician when taking Prozac. You should give a complete medical history, including any history of kidney disease, liver problems, heart problems, seizures, history of diabetes and allergies. Prozac has been known to make individuals drowsy or dizzy, making it necessary to be cautious when performing activities that require a high level of alertness such as driving or operating heavy machinery. Alcohol consumption should also be limited when on this depression medication. Prozac use should also be limited if you have a history of alcohol dependency, liver disease or diabetes. Like many medications, precaution may be necessary when this drug is used by the elderly as they have a higher level of sensitivity and seem to metabolize medications more slowly. This medication may also need to be monitored intensively and used only if necessary if you’re pregnant or plan to become pregnant soon as this medication is believed to pass into breast milk. Because of this possible risk to the infant, Prozac may need to be discontinued or breast-feeding may need to be curtailed while taking this drug. Obviously, continuous discussions with your physician are imperative while pregnant or breast-feeding because of these risks.

Some important information about this depression medication:

It is very important to understand that there can be very serious interactions when taking prozac in conjunction with other medications such as the MAO inhibitors (MAOI’s). When combined, the interaction between prozac and the MAOI’s such as nardil, parnate and marplan and can be fatal. Also, it is important to understand that caution may be necessary when taking prozac over prolonged periods of time. If you are taking any other medications, you need to notify your doctor immediately before starting Prozac.

Prozac Depression Medication Side Effects:

Although the side effects of the depression medication prozac seem to be less than the previous generation antidepressants such as imipramine, amitriptyline, desipramine and nortriptyline, there are still side effects associated with this medication that you need to be aware of. Some of the most common prozac side effects include dry mouth, sweating, insomnia, nausea, drowsiness and headache. Some of the less likely side effects are even considered to be more severe such as unusual weight loss and loss of appetite, decreased interest in sex, flulike symptoms, uncontrollable movements including tremors, and severe and unusual mood changes. Even more potentially dangerous but even less likely prozac side effects include vision changes, white spots and swelling in the mouth and tongue, trouble swallowing, prolonged and painful erection and changes in sexual ability. The most severe prozac side effects are fast and irregular heartbeat and fainting. Although allergic reactions to prozac are rare, they include rash, itching, trouble breathing and dizziness, and swelling. If you notice any of these allergic reactions after initiating treatment with prozac, you need to notify your doctor immediately. A more complete listing of prozac medication side effects follow.

Most Common Prozac Depression Medication Side Effects:

Abnormal dreams, abnormal ejaculation, abnormal vision, increased anxiety, dry mouth, dizziness, reduced sex drive, flulike symptoms, flushing, gas, headache, itching, impotence, loss of appetite, insomnia, nervousness, sinusitis, nausea, sweating, rash, sleepiness, sore throat, weakness, upset stomach, tremors, yawning, vomiting

Less Common Prozac Side Effects:

Abnormal taste, agitation, emotional instability, ear pain, frequent urination, high blood pressure, weight gain, sleep disorders, bleeding problems, chills, confusion, ringing in the ears, loss of memory, palpitations, increased appetite

There are some other even more rare side effects associated with prozac. If you develop any new or unusual symptoms you need to contact your physician immediately.

Prozac and Other Food and Drug Interactions:

Along with the prozac side effects mentioned above, there are also food and drug interactions that can occur when taking this antidepressant medication. The most serious of these interactions may be the interaction of prozac with the MAOI medications previously mentioned. Prozac mixed with these drugs can have a serious and even fatal medication interaction. Also, it is important to recognize that prozac in addition to any other medications can cause the effect to be increased, decreased or altered in various other ways. You should always talk with your physician when taking Prozac with the following medications:

Alprazolam (Xanax)
Carbamazepine (Tegretol)
Clozapine (Clozaril)
Diazepam (Valium)
Digitoxin (Crystodigin)
Drugs that impair brain function, such as sleep aids and narcotic painkillers
Flecainide (Tambocor)
Haloperidol (Haldol)
Lithium (Eskalith)
Other antidepressants (Elavil)
Phenytoin (Dilantin)
Pimozide (Orap)
Vinblastine (Velban)
Warfarin (Coumadin)

Special Warnings If You’re Pregnant or Breast-Feeding:

This medication has not been adequately studied for people who are pregnant or breast-feeding. If you’re pregnant or plan to get pregnant in the future or are breast-feeding your child, you need to be in constant discussion with your doctor to determine whether you may continue with this medication or need to discontinue breast-feeding. This medication is known to appear in breast milk and should probably be discontinued.

Prozac Dosage:

Prozac is usually taken once or twice a day and should be taken exactly as prescribed by your doctor. Also, it needs to be taken regularly to be most effective. If possible, you should take it at the same time every day. Some people have found that it takes prozac as much as four weeks to feel significant effects from this medication and to feel any relief from their depression symptoms. Additionally, some doctors recommend continuing prozac for approximately nine months beyond the initial three-month treatment period. Some people with a diagnosis of obsessive-compulsive disorder may not feel the full effects for as much as five weeks.

Recommended Prozac Depression Medication Dosages:

The most common prozac dosage is 20 mg daily, usually taken in the morning. Your doctor may increase your dosage after several weeks if there has not been adequate symptom improvement. Elderly persons with liver and kidney disease and individuals taking other medicines may have their dosage adjusted by their physician.
When taking a prozac dosage over 20 mg, the physician may ask that you take two smaller doses in the morning and noontime rather than just once a day.

The usual dosage of prozac for depression is between 20 mg and 60 mg per day. The usual prozac dosage for obsessive-compulsive disorder usually ranges from 20 mg to 60 mg per day, although at times the maximum of 80 mg has been prescribed. For bulimia nervosa, the usual prozac dosage is 60 mg taken in the morning. The doctor may start at a lower dosage and increase to these levels over time. The most common dosage of prozac for premenstrual dysphoric disorder is 20 mg per day.

For patients who have been treated successfully with daily prozac, the doctor may consider a more long-acting form sometimes referred to as prozac weekly. The doctor may then ask you to discontinue daily doses for about seven days before taking your first weekly dosage.

You should never take more than one dosage of prozac at a time. If you miss your most recent dosage you need to take it as soon as possible. If a significant amount of time has passed, you may need to miss that dosage and return to your medication routine as soon as possible.

Prozac Over Dosage:

Like all medications, prozac depression medication needs to be taken as prescribed. Dosages in excess to the prescribed amount can be dangerous and even fatal. Combining prozac with other medications may also result in over dosage. If you suspect an overdose of prozac, you need to contact your doctor or local emergency room as soon as possible.

The most common symptoms of prozac over dosage are sleepiness, vomiting, seizures, nausea, and rapid heartbeat. The less common symptoms of prozac over dosage are irregular heartbeat, high fever, fainting, delirium, coma, mania, low blood pressure, rigid muscles, sweating and stupor.

By Paul Susic Ph.D. Licensed Psychologist

What are the depression medications and how do they work?

How do depression medications work?

The depression medications work through their effect on the biochemistry of the brain which then affects our thinking processes. Our thoughts, actions and moods are activated by the nerve cells in the brain which are referred to as neurons. The thoughts, actions and moods that we experience in our daily lives involve neurons in specific areas of the brain being activated and then communicating with other neurons using a biochemical referred to as a neurotransmitter. These neurons frequently work together with other neurons, which then form networks in specific areas of the brain which allows us to complete specific actions and thought processes.

Some of the main biochemical messengers (neurotransmitters) which communicate with other neurons when completing thoughts and actions are of specific biochemical types including norepinephrine and serotonin. There are other neurotransmitters that are very important to our lives and functioning such as dopamine, which is involved in various mental processes such as when you feel pleasure or happiness. However, the neurotransmitters norepinephrine and serotonin have been found to correlate highly with how a person thinks and feels and experiences specific moods. Depression medications tend to primarily increase these two neurotransmitters. Medications of these types are usually referred to as SSRI’s or selective serotonin reuptake inhibitors. The SSRI’s are believed to focus on increasing the level of serotonin even though their selectivity is now somewhat controversial. Some of the newer antidepressant medications are known to increase both serotonin and norepinephrine and are referred to as serotonin norepinephrine reuptake inhibitors or SNRI’s.

There are some depression medications that have been around for a long time including the tricyclic antidepressants and monoamine oxidase inhibitors or what are referred to as MAOI’s. These medications are believed to affect several of the neurotransmitters in the brain rather than selectively affecting just serotonin and norepinephrine.

Antidepressant Medication: Selective Serotonin Reuptake Inhibitors:

As previously mentioned, these depression medications are believed to selectively affect the neurotransmitter serotonin in the brain. This selectivity however is currently in debate among researchers and doctors. The description of selective serotonin reuptake inhibitors may not be an accurate description due to this debate of their selectivity. However, although this issue is somewhat controversial they are still referred to in conventional medicine and by physicians as belonging to the SSRI class of medications. The SSRI depression medications follow.

Selective Serotonin Reuptake Inhibitors:


Additional depression medications also have some effect on the serotonin level of the brain but are not usually referred to as selective serotonin reuptake inhibitors. These include:

trazodone (Desyrel)
vilazodone (Viibryd)
etoperidone (Axiomin, Etonin)
vortoxetine (Brintellix)
buspirone (BuSpar)

These medications are also included in this section due to their similar side effect profile.

The SSRI’s seem to be generally well tolerated but do have some common side effects which include drowsiness, difficulty achieving an orgasm and heartburn. More specific side effects are included in relation to specific medications on their respective pages. They can also affect a loss of appetite at times and have been known to also interact poorly with other medications. You should always consult your pharmacist or physician prior to mixing these medications with any other drugs.

Serotonin Norepinephrine Reuptake Inhibitors (SNRI):

One of the more recent depression medications which are marketed for their effect on both norepinephrine and serotonin are the serotonin norepinephrine reuptake inhibitors. The medications which fall within this category follow.

Serotonin Norepinephrine Reuptake Inhibitors:

venlafaxine (Effexor)
tofenacin (Elamol, Tofacine)
dezvenlafaxine (Pristiq)
duloxetine (Cymbalta)
levomilnacipran (Fetzima)
milnacipran (Ixel, Savella)

Additional depression medications that affect primarily serotonin along with norepinephrine are also not included in the category of SSRI’s including:

setiptline (Tecipul)
mirtazapine (Remeron)

There are many critics of the medication classification system which state that medications seem to be classified in a rather arbitrary way possibly to switch patients from one drug class to another if their previous medication does not seem to work.

Many of the same negative side effects listed for the SSRIs can also be included in the side effect profile for SSRI’s. These may include withdrawal symptoms and possible tardive dysphoria. Duloxetine (Cymbalta) and venlafaxine (Effexor) have both been included in the top five medications reported to the FDA MedWatch associated with very serious concerns such as violence including injuries to self, suicidal tendencies and possible homicidal ideation.

Depression Medication: The tricyclics

The tricyclic antidepressant medications are some of the older depression medications going back several decades. Their name is derived from their chemical structure and are still believed to be effective in combating depression for some people. Unfortunately, they have some side effects which are troublesome for some people that are not shared by the newer SSRI’s and SNRI medications. Some of the primary side effects which seem to be of concern to many people are dry mouth, constipation and drowsiness. Once again, more specific side effects associated with each medication are identified on the individual antidepressant medication pages.

Tricyclic Antidepressant Medications:


All of the tricyclic depression medications are now in generic forms and produced by additional manufacturers.

The Monoamine Oxidase Inhibitors (MAOI’s):

Another classification of medications that have been around for several decades and are still in use are the monoamine oxidase inhibitors or the MAOI’s. They are still found to be effective for some types of depression. However, one of the primary concerns with MAOI’s is that they have very serious, even potentially life-threatening concerns for interaction with other drugs. Your doctor needs to be very involved when taking these medicines in helping you to avoid foods that may interact poorly with these medications resulting in life-threatening consequences.

Monoamine Oxidase Inhibitors (MAOIs):

Parnate (tranylcypromine).
Nardil (phenelzine)

Miscellaneous Antidepressants:

A final category of depression medications that really do not fit well in other specific categories include the following:

Serzone (nefazodone)
Wellbutrin (bupropion
Remeron (mirtazapine)

Depression Medications: Conclusion

Depression medications have evolved significantly over the last several decades with the introduction of newer medications including the selective serotonin reuptake inhibitors and the selective norepinephrine reuptake inhibitors. These medications are frequently selected for their effectiveness for specific symptoms as well as well as their respective side effect profiles. Although these medications are marketed according to specific categories as previously mentioned, these categories do not always represent the selectivity and specificity of the neurotransmitters that are affected. Also, older antidepressants such as the tricyclic antidepressants have had a long history and continue to demonstrate effectiveness for some mood disorders, although the side effect profile seems to be more troublesome for some individuals.

By Paul Susic Ph.D. Licensed Psychologist

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