Prozac- What you should know before you use it.

       Prozac- What you should know before you use it.

How it acts-

    Prozac, or Fluxoteine hydrochloride, has been widely prescribed since 1986-87 as a popular antidepressant.

    It works by increasing availabity of certain neurotransmitters in the Brain. By increasing available serotonin neurotransmitter in the brain, Prozac brings out a *FEEL GOOD* reaction from the brain. It has now been demonstrated, although only in experimental animals, that it results in growth of new neurons in about a month. It is generally believed that Prozac brings about its antidepressant actions.

by increasing serotonin levels in brain, as well as by stimulating growth of new neurons.

When is Prozac used-?

 A frequently used medication in general practice, Prozac is most commonly used for treatment of Depression

 Started in doses of 10-20 mgs in the beginning and slowly increased up to 60-80mgs, Prozac has brought about drastic improvement in Quality of life of many chronically depressed patients. Benefits of Prozac like improvement in mood, reduced irritability and anxiety, and decrease in severity of other symptoms of depression usually take 3 to 4 weeks to appear. For long term benefits, it has to be used for at least 6 to 12 months.

Besides depression, Prozac has also been used in OCD (Obsessive compulsive disorder), Bulimia and Panic disorders. Prozac relieves the depression associated with these disorders and also decreases severity of panic attacks as well as relieves anxiety.

Another popular use of Prozac is in PMS. It relieves physical symptoms (like body ache) as well as mood related problems (like depression and irritability) which are associated with premenstrual syndrome in women (PMS).

Prozac is generally avoided in children. Like with most anti-depressants, there is a chance of increased impulsivity and suicide attempts in people using these drugs. Children, being inherently more impulsive, are therefore at a greater risk. However, in some serious cases of Major depression and Obsessive compulsive Disorder, Prozac can be used when no other medication shows improvement. But extra precautions have to be taken in such younger patients.

You can not be taking Prozac if-

Like with any medication, Prozac can not be used if a person has a history of an allergic reaction while using Prozac. This allergic reaction can manifest as rash, itching, swelling over face and puffiness of eyes, difficulty in breathing and sometimes may cause death. If, while using Prozac, you experience any of the allergic symptoms, contact your Doctor immediately.

Similarly, avoid using Prozac if you are already using other mood altering drugs or Antipsychotics. Prozac, when used along with other such medications which act on the brain, can cause many drug interactions. In such cases, Prozac has to be used under strict medical supervision.  

It’s a Category C drug in the U.S in pregnancy, meaning there is insufficient data about its effects on the Fetus. So if you are planning a pregnancy while using Prozac, contact your doctor. The doctor would slowly taper the dose of Prozac before finally withdrawing it completely. It is also secreted in the breast milk, so it is recommended you refrain from breast feeding if you are using Prozac.

Patients with severe Liver or renal disease are generally not prescribed Prozac. These organs are involved in the metabolism and excretion of Prozac. If you have a liver or a kidney disease, Prozac would slowly start accumulating in the body as it would not be adequately metabolized and /or excreted. Therefore, if Prozac use is essential in such patients, they are given the drug in very small doses and require constant monitoring.

Prozac is also avoided in Diabetics, especially those who use oral medications to control their blood sugar levels. Prozac is known to cause hypoglycemic attacks and therefore needs to be used cautiously in such patients.

Points to note when you are taking Prozac -

• DON’T STOP ABRUPTLY. - Sudden withdrawal of Prozac can cause rebound Depression which might be more difficult to treat then even the original symptoms of depression. Prozac has to be withdrawn by slowly decreasing the dose and finally tapering it off completely over a few weeks.

• Look for sudden changes or worsening of depressive behavior -. Prozac may cause aggressiveness and violent behavior in some people. It also leads to impulsive behavior. If you have any suicidal ideas, see you doctor immediately. These changes happen usually while starting Prozac or when increasing the dose. Be especially careful with younger, adolescent patients.

• Symptoms like nausea, vomiting, restlessness, Tremors, abdominal pain, diarrhea, confusion, increased activity and hyperpyrexia (fever) sometimes appear due to the increased serotonin levels and its effects on neurochemical balances within the brain. It may sometimes get very serious. Consult your doctor; certain tweaking may have to be done to the dosage levels.

• It may cause decreased libido and impotence.

• Contact your doctor immediately if you get a Rash. It might be the first sign of allergy to Prozac.

• Take it in the morning, preferably with food. Prozac may cause drowsiness. So avoid using heavy machinery or driving.

• If you miss any dose, DON’T DOUBLEDOSE the next day. Just carry on with the normal daily dose even after any skipped doses.

• Be Patient- Beneficial effects take up to 3 to 4 weeks to appear. For sustainable, relapse free improvement in depression, it needs to be taken usually for at least 6 to 12 months.

 Written by-

Dr. Neelesh Bhandari

MBBS (AFMC), MD (Path.)std

Masters in Human rights.