Guest Author - Carolyn Chambers Clark, ARNP, EdD

What is Prozac used for?

Prozac is used for endogenous depression that consists of depressed mood, low energy, low self-esteem, changes in appetite or sleep, loss of interest in usual activities, decreased sex drive, extreme fatigue, suicidal thoughts, feelings of worthlessness or guilt, slowed thinking and decreased ability to concentrate.


Does Prozac relieve depression and negative feelings?

Prozac may not work as well as intended. A study in the March 30th, 1996 issue of Lancet found that Prozac didn't improve fatigue, problems with thinking or reasoning, sleep disturbances or depression. Dr. Peter Breggin, MD, points out that 75% of the Prozac patients did not finish the drug studies due to adverse reactions to the Prozac. Dr. Breggin also says that the drug company studies found no difference between Prozac and a sugar pill.

How does Prozac work?

Like all antidepressants, Prozac is supposed to affect the balance of neurotransmitters (chemical signals) in the brain that control mood. Prozac is the first of a new class of drugs that zeroes in on serotonin and blocks its removal from its site of action on neurons. The serotonin is believed to improve the mood. The resulting increase in brain serotonin is also thought to be responsible for Prozac's adverse effects.

It is not known how long Prozac relieves depression past 6 weeks, since that's as long as it's been studied. This is a problem since it is generally agreed it takes several months or longer of drug therapy to produce the desire results. For this reason, anyone on Prozac should be carefully re-evaluated periodically after 6 weeks.

What are Prozac's adverse effects?

* One in 7 people had to quit taking the drug during pre-marketing trials because of adverse effects, mostly psychiatric effects, such as agitation and depression. (It is not unusual for antidepressants to cause depression.)

* The most frequently reported adverse effects of Prozac (found in 15-25% of those who take it) include nausea, nervousness, anxiety, headache, and insomnia. Nausea is usually worse at first and may diminish after a few weeks of treatment.

* Dry mouth, sweating, diarrhea, tremor, loss of appetite, and dizziness are reported by 7-15% of Prozac users.

* Impotence and inability to achieve orgasm are infrequent side effects, as are seizures.

* Four percent of Prozac users report a rash. Stop taking Prozac if this occurs. In rare cases the rash may be severe and is accompanied by fever, swollen lymph nodes, and aching joints. Rare severe cases may require hospitalization and steroid treatment.

* Restlessness, constant pacing and purposeless movements of the feet and legs, occur in 10-25% of Prozac users. Symptoms of Parkinson's disease may be exaggerated.

* A rare side effect is a flip from depression into mania or extreme agitation. Hospitalization and treatment with lithium may be required.

*One of the most frightening side effects, reported in about 3.5% of people taking Prozac, is an intense preoccupation with suicide. Some attempted and were successful suicides. This effect is thought to result from the drug's profound effect on the neurotransmitter whose role in violence, agitation and suicide is not well understood. Even after Prozac was discontinued, unrelenting violent suicidal thoughts persisted from 3 days to 3 months. Hospitalization with close supervision may be required until suicidal thoughts subside.

*The most frightening side effect is that Prozac can worsen the mental condition of many adults and children and even contribute to psychosis and violence. Dr. Peter Breggin investigated these dangers in several books and scientific reports (including Your Drug May Be Your Problem: How and Why to Stop Taking Psychiatric Drugs) and the dangers of drug-induced psychosis and violence have been underscored in several shootings:

- Littleton's Eric Harris was taking the Prozac-like drug, Luvox, which has at least a 4% rate of producing mania in short-term studies of children. Mania includes the feelings of God-like grandiosity and omnipotence, elaborate planning, paranoia, and violence.

- Kip Kinkle, a boy who killed his parents and opened fire at his Oregon school in 1998, had been receiving psychiatric treatment and was thought to be taking Prozac sometime in the past and Ritalin at the time of the shooting.

- Reuters reported on Sptember 1, 1999 that Prozac had been found in the van of Mark Barton, the man who killed his wife, his two children, and rampaged at two stock brokerage firms in Atlanata in late July.

What is the dosage of Prozac?

The usual initial dose of Prozac is 20 milligrams a day, taken in the morning with or without food. Older adults should start on 5 milligrams a day because they are more sensitive to adverse effects. Also anyone with kidney or liver disease should use the 5 milligram dose.

What works as well as Prozac, but has no side effects?

Reading self-help books, psychoatherapy, exercise, support from family and friends, or a change in environment. Some depression is medication-induced (barbiturates such as phenobarbital; tranquilizers such as Valium and Halcion; some heart drugs and beta-lockers, high blood pressure and drugs for abnormal heart rhythms; ulcer drugs, antiparkinson drugs, steroids, anticonvulsants, antibiotics, diet drugs, painkillers and some other drugs),and can be relieved by reducing the dose of the culprit drug, or switching to another drug that does not cause depression.

Sources:

Breggin, Dr. Peter R. Prozac story misleading. American Psychological Association Monitor.
July, 1994.

Wolfe, Dr. Sidney M. Prozac. Public Citizen Health Research Group Health Letter, June, 1990.

Wolfe, Dr. Sidney M. The doors of deception? Public Citizen Health Research Group Health Letter, May, 1994.

This article is for information purposes. For treatment, consult your health care practitioner.