Fluoxetine

Brand Name:

Prozac

Drug Class:

Selective Serotonin Reuptake Inhibitor

How it works:

Boosts the effects of a neurotransmitter found in the brain called Serotonin. It also boosts the effects of the neurotransmitters norepinephrine, and dopamine in an area of the brain called the pre-frontal cortex.

What makes it unique:

This medication has a long half-life. This means that it takes your body a lot of time to break down the medication and clear it. This is generally seen as a good thing because it is OK to forget the occasional dose. Also, withdrawal symptoms are rare because if medication is stopped, the level slowly decreases over time as the body metabolizes the compounds. The norepinephrine and dopamine increases can lead to a little boost of energy. This can be a good thing if your depression symptoms are making you feel tired. This could be a bad thing if the opposite is happening and you are having trouble sleeping due to your depression.

Side effects:

Headaches and stomach aches are common when starting, but then often goes away. Sexual dysfunction can also occur. Increased serotonin can cause diminished dopamine release, which may lead to emotional flattening and apathy in some patients. Fluoxetine’s 5HT2C antagonism could contribute to agitation and anxiety.

Rare side effects include seizures, induction of mania, and activation of suicidal ideation in people age 24 and younger.

How effective is it:

There are hundreds of studies analyzing Fluoxetine. Here is just a taste.
(1) A study from 2000 assessed 417 patients taking either Fluoxetine or placebo. 58.6% of patients taking Fluoxetine responded to treatment as compared to 33.8% of patients taking placebo. Additionally, 39.8% of patients taking Fluoxetine had remission of symptoms as compared to 22.3% of patients taking placebo.

(2) A large analysis of 4,120 patients compared Fluoxetine to placebo or to another class of antidepressants called “Tricyclic Antidepressants”. Fluoxetine beat placebo with a response rate of 52.7% compared to 32.9%. Fluoxetine beat out the other class of antidepressants narrowly, with a 53.3% response rate compared to 49.1%.

Clinical experience:

I have seen patients do well on this medication. It can be helpful when someone with depression feels fatigued and has little motivation. Also, if the patient is forgetful and misses the occasional dose, then this is a good choice. Pharmaceuticals should never be used as the sole treatment for mental illnesses. Therapy, exercise, meditation or other treatments should always accompany prescriptions.

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Sources:
1. Beasley CM, Jr, Nilsson ME, Koke SC, Gonzales JS. Efficacy, adverse events, and treatment discontinuations in fluoxetine clinical studies of major depression: A meta-analysis of the 20-mg/day dose. Journal of Clinical Psychiatry. 2000;61:722–728

2.Bech P, Cialdella P, Haugh MC, Birkett MA, Hours A, Boissel JP, Tollefson GD. Meta-analysis of randomised controlled trials of fluoxetine v. placebo and tricyclic antidepressants in the short-term treatment of major depression. British Journal of Psychiatry. 2000;176:421–428.