When To See A Doctor
If your depression symptoms return for more than a few days, it’s time to see your doctor. But even if you feel like your antidepressant isn’t working, it’s important to keep taking it until your doctor advises otherwise. You may need a dosage increase or a slow tapering off process. With many antidepressant medications, stopping their use too quickly can cause withdrawal effects such as:
- Greater anxiety
- Suicidal thoughts
Early warning signs of breakthrough depression are the symptoms you typically experience when an episode of depression is coming on, says Nestadt. Depression symptoms vary from person to person, but signs include:
- Low mood
- Changes in sleep or appetite
- Loss of interest in previously enjoyable activities
If your symptoms return, don’t worry adjusting the dose or switching to another antidepressant often solves the problem.
Your Depression Is Gone
If youve been taking an antidepressant for at least six months and youve achieved remission, its important to slowly taper off your depression medications with the help of your physician. Antidepressants, particularly selective serotonin reuptake inhibitors , can produce physical symptoms of withdrawal if you stop taking them suddenly, he says. So, you need to reduce the dosage of depression medication slowly, usually over a few weeks.
You may experience some depressive symptoms when discontinuing antidepressants, but this does not mean the depression is returning. Unfortunately, some people stay on their antidepressants longer than needed because the symptoms of discontinuing SSRIs can be mistaken for signs of returning depression.
Work with your doctor to distinguish between the two. You may need to go even slower than a few weeks when tapering off your antidepressant to prevent these withdrawal symptoms.
Other Uses For This Medicine
Fluoxetine is also sometimes used to treat alcoholism, attention-deficit disorder, borderline personality disorder, sleep disorders, headaches, mental illness, posttraumatic stress disorder, Tourette’s syndrome, obesity, sexual problems, and phobias. Talk to your doctor about the possible risks of using this medication for your condition.
This medication may be prescribed for other uses ask your doctor or pharmacist for more information.
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How Much To Take
The usual dose of fluoxetine is 20mg a day in adults. However, you may be started at a lower dose which is gradually increased to a maximum dose of 60mg a day. Some people might need to take a lower dose of fluoxetine, or to take it less often. This includes people with liver problems, and elderly people.
The usual dose of fluoxetine in children is 10mg a day but this may be increased to 20mg a day.
Your Mood Has Improved But Youre Still Not Yourself
If you experience some relief on an antidepressant, but its not the relief you hoped for, it may be time to try something new, Dr. Thomas says. Options include another depression medication or the addition of counseling, psychotherapy, mood-boosting cardio exercise, or light therapy to your treatment regimen. The combination of medication and other mood-brightening treatments can speed your recovery and reduce your overall time on antidepressants, she says.
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Prozac Use While Pregnant Or Breastfeeding
It may not be safe to take Prozac during pregnancy. Taking the drug during pregnancy can increase the risk of heart problems in the fetus.
If you take Prozac during pregnancy, consider enrolling in a pregnancy registry. Pregnancy registries collect details about the effects of a drug used during pregnancy. This information can help researchers understand the risks of using the drug during pregnancy.
To enroll in the National Pregnancy Registry for Antidepressants and report side effects of Prozac if used during pregnancy, visit the registrys site. Or call 844-405-6185. Its important to talk with your medical professional about the risks and benefits of taking Prozac while youre pregnant.
Additionally, Prozac can pass into breast milk. If youre breastfeeding while taking Prozac, its recommended that you watch your child for these side effects:
- irritability or agitation
Some Drugs Go Too Far Dulling Emotions Across The Spectrum A Dose Adjustment Or A Switch To A Different Medication Can Help
When your doctor prescribes a medication for depression, the goal is to reduce painful feelings of sadness or hopelessness. The majority of people taking the most commonly prescribed antidepressantsselective serotonin reuptake inhibitors improve substantially. But sometimes, SSRIs go beyond improving mood and make a person feel too little emotion. “Some people feel like they’ve lost the richness of daily life,” says Dr. Michael Craig Miller, assistant professor of psychiatry at Harvard Medical School.
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Prozac For Episodes Of Depression Caused By Bipolar I Disorder
Bipolar I disorder means someone has had at least one episode of mania. Prozac is used to treat the episodes of depression that also happen with this condition.
Prozac can be used to treat episodes of depression in adults and in children ages 10 years and older. For this purpose, Prozac is taken in combination with olanzapine .*
* Fluoxetine is available in combination with olanzapine as the brand-name drug Symbyax. Your medical professional or pharmacist can advise whether Symbyax is right for you.
Make Adjustments If Necessary
Increase the Dose or Switch?
In general, it takes approximately 4 to 6 weeks for antidepressants to work. If you are still experiencing symptoms after this amount of time, talk to your doctor. You may need to increase the dose of your current antidepressant drug or switch to another one altogether. Some people experience treatment failure with the first antidepressant they try. In these cases, switching to a medicine in a different class may do the trick. It may take a full 3-month period to experience maximum benefits from an antidepressant. Very rarely, some individuals who have been on an antidepressant for some time may notice that the drug stops working. Always discuss any difficulties you’re having with any drug with your health care professional. Untreated depression is a risk to your mental health.
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What You Can Do
Lifestyle choices can affect how well an antidepressant works for you. Itâs important to get enough rest and avoid recreational drugs and alcohol. With some medications, you need to stay away from citrus juices like orange or grapefruit juice.
A good relationship with your doctor is also key, especially when youâre not feeling well or your medication isnât working as you expected. And talk therapy works hand-in-hand with the right medication. It can help you understand your illness and manage stress and your emotions.
Side Effects: A Closer Look
This section provides a close-up look at key side effects of Prozac.
Prozac can cause , which may lead to weight loss.
So if you have weight loss with Prozac, we recommend telling your medical professional right away. Theyll help determine if your weight loss is caused by the condition youre using Prozac to treat, or if Prozac itself may be causing the weight loss.
Tips for managing
If youre concerned about weight loss with Prozac, a medical professional may be able to answer any questions you have. They may monitor your weight while youre taking the drug. They can also suggest ways for you to maintain a weight thats healthy for you.
Taking Prozac can cause tiredness. This was a common side effect in studies of the drug.
However, Prozac can affect people differently. Both tiredness and insomnia are possible side effects of the drug. So its possible that Prozac could either make you sleepy or keep you awake.
Tips for managing
Tiredness with Prozac can lead to problems with thinking, coordination, or judgment. For this reason, its recommended that you avoid driving until you know how Prozac affects you. Youll likely know how Prozac will affect you after taking several doses of the drug.
- skin rash
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Zoloft Vs Prozac: Which Is More Effective
The good news is that both Zoloft and Prozac are comparable in terms of being able to effectively treat major depressive disorder , according to a study published in International Clinical Psychopharmacology. The study found that both people on Zoloft and people on Prozac showed measurable improvement in their symptomsâand this improvement was maintained for the duration of the study.
However, while both medications were found to be similarly effective, the study also found that around 10% of people stopped taking Zoloft because it was not working for them, compared to around 20% of people who stopped taking Prozac for the same reason. In other words, when they work, both work comparably well. But more people may find that Zoloft works for them compared to Prozac.
The study also found that the rate of adverse events was similar for both medications, meaning around the same percentage of people taking each medication experienced side effects. The people taking sertraline , however, rated the side effects as less severe compared to the people taking fluoxetine .
You Feel More Energetic But Still Feel Blue
If you feel more physical energy after starting an antidepressant, but you still have depression, thats good and bad news, says Gabriela Cora, MD, a psychiatrist in Miami. It means the depression medication is starting to work, but not in the right way.” Increased physical energy combined with depression is a bad combination that can make you act out or increase your risk of suicide, she explains. So, report these symptoms to your doctor right away, urges Dr. Cora.
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B Bipolar Features: Depression With Short Duration Hypomania
Another area where we see this is short duration hypomania. About 1 in 20 patients with recurrent depression have brief hypomanias that are classic and recurrent but never last long enough to meet DSM criteria for bipolar they last less than 4 days. Jules Angst published a remarkable study where he showed the chance mood worsening on an antidepressant rises steadily with the duration of hypomania from 1% in patients with no history of hypomania, to 9% if theyve had it for less than a day, 14% for 2-3 days, and then we get into the real bipolar levels 4 days the cut off for bipolar II the risk is 27% and if theyve ever had hypomania for more than a week the risk of getting worse on an antidepressant is 38%. But, still, thats only 38% its not 100% none of this is absolute.
Drug Features At A Glance
Prozac and Lexapro are antidepressant medications. They belong to a class of drugs called selective serotonin reuptake inhibitors . They help treat depression by boosting the activity of the chemical serotonin. Serotonin is made in both your brain and intestines. Its linked with mood control and other functions of your body. By enhancing serotonin, these drugs treat symptoms of depression.
The table below outlines some features of Prozac and Lexapro at a glance.
|Does this drug have potential for misuse?||no||no|
If you need to stop taking the drug, your doctor will slowly reduce your dosage to keep symptoms from coming back.
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A Bipolar Features: Depression With Mixed Features
And thats the second type of patient who can get worse on an antidepressant: Depression with mixed features. This diagnosis is new in DSM 5 and you dont have to have bipolar disorder to have it. Its actually quite common in unipolar depression one meta-analysis found that 25% of patients with depression had at least 3 manic features which is the DSM-5 cut off for mixed features. We dont know much about how to treat these unipolar depressions with mixed features. On the one hand, they are more likely to get worse on antidepressants, but on the other hand some will respond to them so its tricky.
Most of the patients I see in practice who have mixed features are already taking an antidepressant.
We covered this in our January 2018 issue, which has a link to the Bipolarity Index. This is a validated rating scale that uses non-symptomatic markers of bipolar like age of onset, treatment response, and family history to assess the likelihood that a patient has bipolar disorder on a 100-point scale. Its particularly helpful when faced with mixed features, because the symptoms are so hard to identify they can look like anxiety, PTSD, or even ADHD.
Mixed features are an area of diagnostic as well as treatment confusion, but we do know that the more the patient has the more likely they are to get worse with antidepressants.
Combination Treatment Is Best
Results of several studies suggest that a combination of antidepressant medication with psychotherapy is the most effective treatment for depression. Mental illness is serious. It is important to take depression medication as directed and to see a therapist regularly. Mental illness is nothing to be ashamed of. Millions of people suffer from depression, anxiety, and other mental health disorders. People should feel comfortable seeking help for mental health disorders just as they would for other organic medical conditions like heart disease or diabetes. Cognitive behavioral therapy helps monitor and change unwanted thoughts and behaviors. Interpersonal therapy helps patients have better and more effective relationships with others.
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Searching For A Solution
Kash believes the same thing would happen in humans. SSRIs can cause anxiety in people, he says, and mice and humans tend to have very similar pathways in these brain regions.
The hope is that well be able to identify a drug that inhibits this circuit and that people could take for just the first few weeks of SSRI use to get over that hump.
Thomas L. Kash
The authors hope that this discovery will lead to the development of drugs to counter the negative effects of SSRIs.
The next step will be to test drugs, preferably ones that are already approved by the U.S. Food and Drug Administration , to see if they can change the anxiety circuit and block the negative side effects of the SSRIs.
A CRF-blocker might work. Pharmaceutical companies have been looking at CRF blockers for the treatment of depression, anxiety, and addiction for some time, but without success so far. Kash does not expect a solution from this quarter just yet.
An alternative to better CRF blockers, he suggests, could be to target the proteins expressed by the BNST neurons. He hopes to identify a receptor that existing drugs can already target.
One of these drugs could prevent people who are starting on SSRIs from having to go through the fear and anxiety stage.
Apart from offering hope to people who are experiencing depression, the discovery also deepens human understanding of the brain networks that underlie fear and anxiety behavior in mammals.
Antidepressants Will Make Me Sick To My Stomach
Most antidepressants do not cause an upset stomach once you and your provider have settled on a fixed dosage. SSRIs cause higher rates of nausea than bupropion and mirtazapine, and rates between SSRIs and trazodone and duloxetine are about the same. Venlafaxine is known for causing nausea more often than SSRIs.
What Antidepressants Can Do To A Brain That Is Not Depressed
There’s a word of warning after research on monkeys finds that an SSRI antidepressant may alter brain architecture if taken by those who aren’t really depressed.
There is new reason to be cautious about using popular antidepressants in people who are not really depressed.
For the first time, research has shown that a widely used antidepressant may cause subtle changes in brain structure and function when taken by those who are not depressed. The drug is sertraline. It is most commonly known as Zoloft and is present in 16 other generic forms in Australia.
There has been long debate about the effect such drugs can have on the architecture of the brain. While the changes it induces in the depressed brain are regarded as advantageous, researchers wanted to know what happens in the brains of those who are not depressed. They wanted to know because these drugs are commonly used for other conditions such as anxiety, bulimia, hot flushes, obsessive-compulsive disorder, post-traumatic stress disorder, stroke recovery and sexual dysfunction
Their study revealed the drugs can have unexpected and unwanted effects.
The drug used in this trial is a SSRI, a selective serotonin reuptake inhibitor, and experts say other drugs in this class work on the same mechanism and chemistry and would likely have the same effect.
How Do Prozac And Lexapro Compare
To learn how Prozac and Lexapro are alike and different, you can refer to this comparison article. Your medical professional or pharmacist can answer any additional questions you may have.
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