Prozac side effects and benefit for depression by Ray Sahelian, M.D.
December 1 2016

 

Prozac is a medication used to treat depression, obsessive-compulsive disorder, some eating disorders, and panic attacks. Prozac (brand name Sarafem) is used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Prozac is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). Prozac works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance. A worsening of symptoms soon after starting the antidepressant Prozac suggests that the drug is unlikely to have a lasting beneficial effect.

 

Prozac side effects
Side effects of Prozac can include nausea, headaches, anxiety, insomnia, drowsiness, and loss of appetite. Prozac has been implicated in serious skin rashes and vasculitis. Increased blood pressure can occur and should be monitored. Seizures have been reported as a serious Prozac side effect. Life-threatening interactions can occur in combination with MAO inhibitors, such as nardil and parnate. A common Prozac side effect is sexual dysfunction such as loss of libido, decrease in genital sensation, and erectile dysfunction.

 

Reversal of sexual dysfunction
Q. Can Prozac and Passion Rx be used the same day?
   A. We suggest not using Passion Rx and Prozac or an SSRI the same day due to potential side effects. If you have a mild case of depression, and your doctor feels you can do fine being off the Prozac a couple of days a week, you could Passion Rx on the off days as long as your doctor approves.

 

Q. Prozac and libido. Are they related?
   A. Yes. Prozac lowers libido by increasing levels of serotonin. Serotonin has an inhibitory effect on libido. Most doctors don't warn their depressed patients that a prescription of Prozac leads to libido loss.

 

Red blood cell damage
Toxins (Basel). 2013. Fluoxetine induced suicidal erythrocyte death. The antidepressant fluoxetine inhibits ceramide producing acid sphingomyelinase. Ceramide is in turn known to trigger eryptosis the suicidal death of erythrocytes characterized by cell shrinkage and exposure of phosphatidylserine at the erythrocyte surface.

 

Galactorrhea
Clin Psychopharmacol Neurosci. 2015. Emerging Hyperprolactinemic Galactorrhea in Obsessive Compulsive Disorder with a Stable Dose of Fluoxetine. While fluoxetine is a frequently prescribed selective serotonin reuptake inhibitor (SSRI), with few major side-effects; altered serotonergic transmissions in hypothalamic pathways might lead to a distressing, and often embarrassing, manifestation of galactorrhea by altering prolactin release in those on Prozac. We report here a case of Prozac induced hyperprolactinemic galactorrhea developing late into treatment on a stable regimen, who responded well to subsequent replacement with sertraline. Based on present finding, we suggest that while SSRIs may share similar mechanisms of action, there exist individual differences in their effects on prolactin secretion pathways.

 

Autism risk
A 2015 study shows that women who take antidepressants in the later stages of pregnancy are more likely to have a child with autism. The study specifies one particular group of antidepressants in particular the SSRIs, or selective serotonin reuptake inhibitors, such as Prozac, Zoloft or Paxil.


Testimonials, reports from users
I took Prozac high doses for over 25 years and stopped because it gave me tinnitus, which is getting worse.

 

Prozac and natural antidepressant combinations
There are several natural antidepressants including SAM-e, 5-HTP, and St. John's wort. It is best not to take them the same day as the medication unless the dosages of both the Prozac and the natural antidepressants are low, for instance half the usual dose. Discuss with your doctor before making such additions.

 

Q. I've been on Prozac for three years and am in the process of weaning off the medication in the hopes of switching to 5-HTP or another natural alternative with fewer side effects. I've read that the withdrawal effects of stopping Prozac can be incapacitating. In your experience, are there nutritional supplements that can mitigate the effect of withdrawal from Prozac? If so, would you have your patients begin these supplements during the weaning process, or only after the weaning is complete and the patient has stopped the medication entirely? (I know I'll have to do this under the supervision of my doctor, but I was hoping I could use your Prozac weaning philosophy as a point of comparison.)
   A. Each patient is different depending how long they have been on Prozac or other SSRIs, the Prozac dosage, how their body reacts, their current mood and disposition, their dietary habits and exercise program, their sleep patterns, etc. etc. Plus, each person responds differently to 5HTP, SAM-e, St. John's wort or other natural supplements, and the dosages and timing can make a huge difference. Each case is unique.

 

Q. Are you aware of problems with taking SAM-e or 5HTP or any other alternative supplements while trying to wean from Prozac? Do you recommend a "weaning program"; e.g., how to skip days on the drug and supplement with something else to maintain the appropriate balance so as not to bottom out and then endure the emotional pain of trying to get back up to speed with alternative help OR returning to Prozac? I understand that 5HTP does not mix well with Prozac. What about 5HTP alone? I don't want to encourage a "serotonin syndrome".
   A. Each person taking Prozac medication responds in a different way and needs a different dosage. Each person taking Prozac medication along with natural supplements will respond in a different way depending on many variables including dosage, severity of depression, length of time taking the medications, etc. There is no simple answer to weaning off Prozac or other statin drugs and using natural supplements. The best one can say is to reduce the medication dosage gradually while using a low dosage of the supplements although if the depression is mild a person could stop the Prozac quickly. There is no single regimen that would apply to everyone. Ideally one should try each natural supplement by itself for a week or two rather than combining them. For instance it is a good idea to try 5-HTP by itself and SAM-e supplement by itself rather than taking them together.

 

I am trying all your recommended herbs for depression and anxiety. Can I take St. John's Wort, and or 5HTP, with Prozac? I am hoping they will enhance the result of the Prozac, which after 30 years leaves me numb but helps with the anger of depression.

 

Prozac and drug interactions
Do not take Prozac with MAO inhibitors or for at least a week after their discontinuation. MAO inhibitors medications should not be taken for at least three weeks after discontinuing Prozac. The same is true for Haldol and antipsychotic drugs. Most medications affecting the brain have the potential to slow reflexes or impair judgment and caution is advised. Prozac should not be taken with 5-HTP or tryptophan when the dosages are high. Low dosages of Prozac, 5HTP and tryptophan may be combined under medical supervision. See tryptophan serotonin information.

 

Prozac and prolactin

What is the effect of Prozac treatment on hormone levels, particularly prolactin? A study found that 5% of men and 22% of women with depression developed new onset hyper-prolactinemia following Prozac treatment for a period of 12 weeks.

 

I have recently started 60mg PO daily and have been taking it consistently for a while. I am not concerned about decreased libido as i am single and completely consumed by my work, which is in fact the reason i am depressed. But i was wondering if Prozac causes gynecomastia?
   There are reports that it can cause gynecomastia.

 

Brand names
Other brand names for fluoxetine include Erocap, Lovan, Zactin, and Auscap.
 

Emails
Q. Last year after taking Prozac for many years I decided to add L-tyrosine to my daily supplements. I added about 900 mg. a day. Soon after that I developed what's been diagnosed as "tics". I'm wondering if the addition of L-tyrosine could have had anything to do with this?
   A. It is possible, but we can't say for sure.

Q. Is tryptophan as good as Prozac for depression?
   A. It's difficult to compare, although they both influence serotonin levels, their mechanism is different. I have not seen head to head studies involving Prozac and tryptophan to know how similar or dissimilar they would be in terms of clinical improvement in depression. 5-HTP is another option in terms of increasing serotonin levels.
 

Q. i would like to look into converting from the antideprressant Auscap 20 to recommended products but do not know how. i am finding that the antidepressant Auscap is not relieving greatly my anxiety which i find i still can get slightly reved up. i have heard of 5 htp but looking at your website there seems to be other things too
   A. There are many natural options to treating depression than Prozac, but each person is unique in which of the natural supplements or herbs they would respond to. You can visit the page on depression and have your doctor help you decide. Alternatives to Prozac include 5-htp, SAM-e, tryptophan, fish oils, Mind Power Rx or a combination.
 

Q. I 've been very concerned about my fingernails for the last several months. I feel that it's related to the fact that my Prozac dosage has been doubled for several months now, and maybe that's the reason why my nails are in such bad shape lately.
   A. We have not had reports of Prozac or an SSRI influencing nails before.

 

Q.  I am suffering moderate ED and decrease in libido. My physician has run tests and all appears in normal limits. I have tried Levitra with some improvement but somewhat disappointing. Under the doctors guidance I have weaned off of Prilosec and fluoxetine Prozac. I am nearly complete with the elimination of Prozac, now take one 20mg every five days and will stop entirely in a week. I feel fine. Head actually is clearer that it has been in some time. No sign of the weariness I suffered ten years ago when I started the Prozac. I believe I am experiencing a slight improvement in the libido.

 

Q. A family member has, according to Vanderbilt University medical center in Nashville TN, a receptor problem. After being on Prozac medication for 20 years he developed serotonin syndrome effect to it and all anti-depressants. Flu like symptoms, teeth chattering. He has been trying to take 5 htp only 10mg every 4 days and same thing happens. 47 year of age, has had open heart surgery for rapid heart beat in 1984, got hepatitis C from blood transfusion during surgery, suffers from allergies chronic fatigue syndrome, and now major depression.

 

Re: weaning off Prozac. I've been attending a state hospital for the past 7 years as an out patient and the doctors there have kept me on the meds for over 7 years. I'm a 25 year old male from South Africa and it's really worrying me as every time I try to wean myself off it i experience withdrawal symptoms such as aggression and a heightened sense of depression. The medication hasn't helped me much but caused me worse side effects and the state doctors that i've seen, advise to put me on another medication which has even worse side effects as they say I'm still struggling with depression and the symptoms i feel when i try to wean off the meds are symptoms of my depression not withdrawal. I really feel i can do without the meds all i need is self motivation as that's what has helped me thus far not the meds because even on the meds i still experienced major depression in the past, but when i ask the doctors for advice no one seems to give the same answer everyone has a different theory some doctors even say i can stop it immediately! I'm really concerned as I've even consulted doctors in the private sector and the advice they've given me isn't any different, please can you advice as I do not know where to turn to next and it's beginning to effect my performance at work and in my social life.

 

I have been on Prozac for 15 years started at 10mg and ended at 40mg. It just basically didn't work anymore and my doctor wouldn't go past the 40mgs. I've been on every other SSRI under the sun and to no avail. Anyhow, I suffer from borderline personality disorder with extreme irritability and depression as a result and have just recently (about 2 weeks ago) started taking St. John's Wort and see a bit of improvement. It was recommended to me to start Sam-E as well. I also keep seeing info on 5-HTP. I see about combining SJW with 5 HTP on low doses, but what about SJW and Same-E or Sam-E and 5 HTP? What's best for the common BPD person and at what miligram? Thanks so much, info from doctors seems to be scarce as they will only deal with the FDA approved I'm finding.
    It is best to take the time for 2 or 3 weeks and learn how each supplement influences you by itself. When combining, lower dosages are used. It is difficult to predict which supplement will work best unless by trial and error. Dosages may need to be adjusted since sometimes a lesser dosage is required over time.