Prozac – The World’s Most Popular Anti-Depressant

Depression blights the daily lives of millions of people worldwide. In the USA alone, it is estimated that 17 percent of the population (between 5-12 percent of men and 10-20 percent of women) will suffer from a major depressive episode at least once in their lives. Indeed, depression is now the most common serious brain disease in the USA.

Although some people try to battle their illness without taking any form of medication, many sufferers find relief in using drug therapy. The most widely used medication today is Prozac. Since its first approval for the treatment of depression in Belgium in 1986 and then in the United States the following year, Prozac has been approved and marketed in more than 90 countries and has been used by more than 54 million people worldwide.

So What is Depression?

It’s unfortunate that the word depression has a double meaning. We will often say we are feeling depressed when we are feeling a bit down or a bit blue but there is a huge difference between that type of a feeling and being clinically depressed. Clinical depression, which is what we are focusing on here, is a medically diagnosable illness although getting a diagnosis is not always that easy.

The symptoms of depression can be very wide ranging and are not always easy to distinguish from just experiencing “the blues”. The World Health Organisation sets out a number of symptoms that a clinically depressed person may display including:

• Two weeks of an abnormally depressed mood
• Loss of interest or pleasure in activities that used to be enjoyable
• Disturbed sleep
• Loss of confidence
• Low self esteem
• Reduced ability to think
• Changes in appetite and unexplained physical symptoms.

Clinical depression can be completely debilitating, preventing the sufferer from functioning at their normal social and psychological level.

What Causes Depression?

There are a number of theories as to why a person develops clinical depression although no one is certain as to the exact cause. Certainly a hereditary factor may play a part. If someone in your immediate family has suffered from depression or bipolar disorder (manic depression), your own risk of developing a depressive illness is increased two to three times.

Finding yourself under stress and/or having to deal with major life events such as the death of a partner or the loss of a job may also trigger a depressive episode, particularly if you are predisposed to depression.

Suffering from another medical condition may lead to depression either from the illness itself, the drugs used to treat the condition or from the stress that comes with being ill. For example, research has shown that people who’ve had a heart attack or cancer have higher than average rates of depression.

Personality type may also play a significant role. For example, those who are anxious or who worry a lot, or those who are particularly sensitive or maintain very negative views on life are all more likely to develop depression. Similarly, people who set themselves very high standards and are perfectionists can often succumb to depression particularly from work or school pressures.

Changes in the Brain and Depression.

Although no one can be absolutely sure why some people develop depression, researchers have been able to establish that for many sufferers chemical changes occur in their brains and indeed, it may be that it is these changes that lead to the depression in the first place. Researchers discovered that depression could be improved by agents that acted to increase synaptic concentrations of neurotransmitters. This finding led to what is known as the monoamine hypothesis of depression – that is to say that the underlying biological basis for depression is a deficiency of certain neurotransmitters which belong to a group of chemicals called monoamines.

Neurotransmitters act as the brain’s communication messengers. When neurons (brain cells) seek to pass on information to other neurons they do so by releasing chemicals (neurotransmitters) that cross the tiny gaps that exist between neurons (the synaptic gaps). Clinically depressed patients were found to have low levels of neurotransmitters and boosting levels of these neurotransmitters was found to relieve their symptoms of depression and restore “normal function”.

The particular monoamine neurotransmitters thought to be involved in the development of depression are serotonin, noradrenaline, and dopamine. Each of these neurotransmitters has a specific role to play. Serotonin helps to regulate emotions, sleep and appetite; noradrenaline is associated with arousal and alertness, and dopamine is linked with pleasure and reward.

The development of the monoamine hypothesis of depression has been of crucial importance in understanding depression and in the development of safe and effective pharmacologic agents for its treatment. However, it is still not known for sure whether monoamines are the primary cause of depression, or whether other factors are causing both the lowered neurotransmitter levels and the depression.

What is Prozac and What does it do?

As we have seen above, people who suffer from depression have an imbalance in their levels of monoamine neurotransmitters. It is thought that depleted serotonin levels in particular may be an important factor in the development and severity of depression.

Prozac seeks to correct this imbalance in serotonin levels by increasing the brain's own supply of the neurotransmitter. It does this by acting to prevent the re-absorption of serotonin.

Unlike some other anti-depressants which appear to affect several neurotransmitters, Prozac only affects serotonin. Because of its specific action, Prozac belongs to a group of anti-depressants known as SSRIs (Selective Serotonin Reuptake Inhibitors). Indeed, Prozac was the original SSRI.

It should be remembered that Prozac cannot cure depression. What it does do, however, is to help you to control the symptoms of depression. This means that for many people taking Prozac they feel better because the symptoms of their illness are dissipated and this helps them return to living a normal life.

Is Prozac just for the Treatment of Depression or can it help with Other Conditions?

Prozac is not just used for the treatment of depression. It is also recommended for the treatment of OCD (obsessive compulsive disorder) and bulimia.

It would be true to say that many healthy people can identify themselves as having elements of OCD. A very mild manifestation of the condition would be something like checking several times to make sure you’ve unplugged the iron before leaving the house. However, when this type of behaviour takes at least an hour a day, is very distressing and interferes with daily life, and at this point OCD is diagnosed.

Bulimia nervosa is an eating disorder in which the sufferer indulges in frequent binge eating episodes that are followed by purging to rid the body of the food just eaten. Most people think of vomiting as purging but it can also involve taking large doses of laxatives or diuretics, exercising compulsively, or fasting.

Getting the Most from Prozac

Using Prozac is no quick fix – it takes time for Prozac to help you. Indeed, it will usually takes 4 weeks or more until you will feel the full affects of the medication. This can mean that the first few weeks of treatment are particularly tough as your body gets used to Prozac at the same time as you are still suffering from the symptoms of depression. This period of time is often called the “acute phase” of treatment. If you experience any side effects, even very minor ones during this period of time, it can often seem very hard to keep going with your medication, as the side effects can feel like they are simply adding to your problems. It is really important however, that you do continue to take Prozac because after a few weeks you will really start to see the benefit of the medication.

You should seek as much support as possible to help you through the acute phase of treatment. The trick is to keep at it as far as taking Prozac is concerned.

Once through the acute phase, you should be starting to feel much better. The next phase of treatment – sometimes called the continuation phase- is aimed at preventing a relapse. Prozac therapy is usually continued for a further period of 4 to 9 months after the symptoms of the depression have gone away. The length of time of the original depressive episode will help to determine how long this continuation phase will last. Throughout your treatment you should be regularly monitored by your doctor as they will be able to determine the appropriate length of treatment. If this continued phase of treatment is successfully completed, full recovery should have been achieved.

For most people therefore, they should take Prozac for a total period of 6-12 months. It is really important to continue taking Prozac for the period of time recommended by your doctor. If you stop treatment because you are feeling better or suffering from mild side-effects, you may suffer a relapse.

For some people however, Prozac treatment should be continued even after they have fully recovered because they are at a high risk of developing depression again. It is well-known that depression has a high recurrence rate:

• Once a person has experienced one bout of depression, they have a 50% chance of having another.
• With two depressive episodes, this risk of developing depression again increases to 70%.
• With three depressive episodes, the risk of recurrence is as high as 90%.

Continuing Prozac therapy for high risk patients may help to prevent another depressive episode from occurring or lessen the severity of a subsequent episode.

Dosage, Side Effects and Warnings

Dosage

Prozac dosage depends upon the condition that is being treated. Your doctor will advise you as to your appropriate dosage. The treatment guidelines are:-

Daily doses should not exceed 80 mg and it is usually recommended that you take Prozac in the morning. It can be taken with or without food.

Do not take a double dose if you miss a dose. Simply continue with your next scheduled dose.

It is also really important to continue taking Prozac even though you might not see any initial signs that your symptoms are improving. It usually takes about 4 weeks before the full benefits of Prozac are felt. Also, it is as important not to stop taking Prozac when you feel better. One of the goals of Prozac therapy is to try and prevent another depressive episode from reoccurring and your doctor will have worked out an appropriate period of treatment with this in mind. You should be monitored regularly throughout your treatment by your doctor.

Side Effects

As with all medications, you may experience some side effects when taking Prozac. These can include:

• Skin rash
• Allergic reactions
• Serotonin syndrome which has a number of symptoms including fever, joint stiffness, muscle shaking, dizziness when getting up, excessive perspiration, irregular heartbeat, confusion, irritability or extreme agitation
• Sensitivity to daylight
• Weight loss
• Gastrointestinal disorders such as diarrhoea, nausea or vomiting
• Nervous system complaints including headache, sleep disorders, dizziness, anorexia, fatigue, feelings of euphoria, transitory abnormal movements such as muscle spasms or trembling. You may also experience hallucinations, manic reactions, confusion, agitation, anxiety and associated symptoms (e.g. nervousness), difficulty concentrating and thinking and panic attacks
• Respiratory complaints including pharyngitis and difficulty breathing
• Urogenital disorders including sexual dysfunction, prolonged and/or painful erection and milk secretion

You may also experience other side effects including hair loss and abnormal vision. This list is not intended to be exhaustive and you should discuss any side effects with your doctor.

Effects on stopping treatment

When you stop taking Prozac you may experience dizziness, a tingling sensation, headache, anxiety and nausea. Generally if you do experience any of these effects, they will be moderate and temporary but if you have any concerns at all you should raise them with your doctor.

Warnings

Do not take Prozac if you have ever had any type of allergic reaction to fluoxetine or any other ingredients in the capsules.

Prozac could interfere with other anti-depressants, particularly MAO inhibitors and other SSRIs. Do not combine Prozac with any other anti-depressants unless you are doing so under the guidance of your doctor.

With regard to MAO inhibitors, you must leave a period of two weeks between finishing treatment with an irreversible MAO inhibitor and starting Prozac treatment. However, you can start Prozac the day after ending treatment with a reversible MAO inhibitor. If you have been taking Prozac but need to change to a MAO inhibitor, wait at least five weeks between stopping Prozac and starting any MAOI.

As with all medications you should fully advise you doctor of any medications you are currently taking or have taken before using Prozac as these may interact with Prozac. It may be necessary to adjust your dosage or discontinue Prozac therapy. You should be aware that this warning includes over the counter preparations as well as prescription medications. This warning is particularly relevant in the case of the following:

• Drugs that affect blood coagulation
• Preparations containing St John's Wort
• Phenytonin and carbamazepine (used for the treatment of epilepsy)
• Tramadol
• Triptans (used for the treatment of migraine).
• Lithium or tryptophan
• Flecainide and encainide (for the treatment of heart arrhythmias)
• Tricyclic antidepressants

You should exercise caution when taking Prozac if:

• If you suffer from or have suffered in the past from convulsions.
• If you suffer from or have suffered in the past from some type of hemorrhage.
• If you have ever received electroconvulsive therapy (ECT)
• If you suffer from or have suffered diabetes, heart disease, liver or kidney disease or mania /hypomania

Suicidal tendencies (including suicide attempts) that can be experienced during depression, may still occur until a significant recovery has taken place.

Pregnancy and breast feeding

You should only take Prozac while you are pregnant if your doctor believes that the expected therapeutic benefits justify it. This is especially true during the final stage of pregnancy and just before you give birth.

Do not take Prozac if you are breast feeding because Prozac is excreted into breast milk.

Driving and operating machinery

Prozac may cause drowsiness, lower your reflexes and ability to react. It is therefore advisable not to drive, operate machinery or engage in other tasks that require you to pay special attention, until you know how you react to your Prozac treatment.

Alcohol

You should avoid alcohol while taking Prozac.

Above all, it is vitally important that Prozac is only taken under the supervision of your doctor and your progress throughout your treatment period is regularly monitored.

Caution:
As with most anti-depressants, Prozac could interfere with other anti-depressants, particularly MAO inhibitors (including Gerovital-H3®) and other SSRIs (such as Paxil®). Therefore, if you wish to combine Prozac with any other anti-depressants, you must only do so under the guidance of a physician.