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

Psych Talk

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