MULTIPLE SCLEROSIS
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Prozac / FLUOXETINE What
is Prozac? Prozac
(fluoxetine) is an antidepressant medication originally approved by the FDA in
1987 and currently available for the treatment of depression,
obsessive-compulsive disorder, and bulimia nervosa. Prozac has also been used
off-label (which means a use not reviewed by the FDA) to treat panic disorder.
Prozac is believed to work by blocking the reabsorption of serotonin, a
neurotransmitter or chemical messenger in the brain. It is a member of the
serotonin-reuptake inhibitor (SSRI) family, as are Zoloft (sertraline) and Paxil
(paroxetine). How
is Prozac different from other antidepressants?
Prozac
is overall as effective in relieving depression as older tricyclic
antidepressants (TCAs) such as imipramine. However, not all antidepressants are
equally effective for a specific individual. Prozac causes fewer adverse
heart-related events (such as a drop in blood pressure or unusual rhythm) and
fewer anticholinergic effects (dry mouth, constipation, blurred vision, urinary
retention) than TCAs. And it is less likely to cause drowsiness or weight
changes also associated with the older TCAs. A special diet is not necessary
when taking Prozac, which may be the case with other antidepressants known as
monamine oxidase inhibitors (MAOIs). The incidences of death resulting from an
overdose of Prozac have been extremely rare, which may help doctors feel more
comfortable prescribing it. What
are the side effects of Prozac? The
most common side effects seen in people taking Prozac include anxiety or
nervousness, insomnia, drowsiness, headache, diarrhea, and rash. In addition,
sexual side effects (reduced arousal or satisfaction) may occur. Prozac has also
been shown to cause changes in appetite and weight, usually resulting in weight
loss rather than weight gain. Most side effects are mild and brief, usually
subsiding in a week or two after beginning treatment. Particularly bothersome
side effects can be treated with medication or by reducing the dose of the
antidepressant, changing the time the medication is taken, or switching to a
different antidepressant. Is
there a significant risk of suicide for people taking Prozac?
Suicide
is always a risk in people with severe depression, and it may persist until
significant remission occurs. However, consumers and their families must be
cautious during the early stages of treatment with all antidepressants, when
energy and activity may return before mood improves. At this time - when
depression is still severe but when a depressed person may have more energy to
take action - the risk of suicide can temporarily increase. How
does Prozac interact with other medications?
Prozac
should not be taken until at least two weeks after MAOIs (e.g., Nardil and
Parnate) are discontinued. Similarly, MAOIs should not be taken for at least
five weeks after treatment with Prozac has been discontinued. The interaction
between the two could produce fatal results. Consumers should always consult
with their physicians when taking medications in addition to the prescribed
antidepressant. Alcohol consumption should always be avoided when taking
prescribed medications. What
is the standard dose of Prozac? Prozac
is used to treat depression, obsessive-compulsive disorder, and bulimia nervosa.
For the treatment of depression and obsessive-compulsive disorder, a dose of 20
mg/day, taken in the morning, is recommended as the initial dose. A dose
increase may be considered after several weeks if insufficient clinical
improvement occurs. The maximum Prozac dose should not exceed 80 mg/day. For the
treatment of bulimia nervosa, the recommended dose is 60 mg/day, taken in the
morning. Prozac doses above 60 mg/day have not been systematically studied in
people with bulimia. How
long should I take Prozac? While
there are no studies that answer the question of how long to continue Prozac,
depression, obsessive-compulsive disorder, and bulimia nervosa are usually
chronic conditions, and it is reasonable to consider longer term treatment for a
consumer who is responding well. After 6 months, particularly for depression, it
is reasonable to consider trying to reduce the dose to see whether symptoms
return. As with other medications, discontinuing Prozac should be discussed with
your doctor and a plan for discontinuation should be developed rather than
simply stopping on your own. In clinical trials, Prozac's antidepressant
efficacy has been maintained for periods of up to 38 weeks, following 12 weeks
of acute treatment. For OCD and bulimia nervosa the efficacy of Prozac beyond 16
weeks has not been documented in controlled trials. However, people have
continued in therapy for up to an additional six months without loss of benefit.
Dose adjustments maintain the consumer on the lowest effective dosage, and
consumers should be periodically reassessed to determine the need for continued
treatment. How
soon after starting treatment will I feel better?
Someone
starting treatment with Prozac may notice some improvement, particularly in
concentration and increased energy, within one week. As with other
antidepressants, it usually takes three to six weeks for the full therapeutic
effect of the drug to be felt. The medication should be taken at the prescribed
dose for six full weeks before evaluating its effectiveness. Reviewed
by Rex Cowdry, M.D., NAMI medical director, March 2001 Permission
is granted for this fact sheet to be reproduced in its entirety, but the NAMI
name, logo, and contact information must be included.
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