Fluoxetine is sold under the brand name "Prozac".
Fluoxetine started the new wave of psychotropic medications when it was released in 1988. It is FDA approved for Major Depression, OCD, Bulimia Nervosa, Panic Disorder, Premenstrual Dysphoric Disorder and, in combination with olanzapine, for Bipolar Disorder, depressed phase. It has been generic for several years now and is the least expensive of the generic antidepressants.
Fluoxetine, like its cousins, sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), paroxetine (Paxil) and fluvoxamine (Luvox), reversibly blocks the recycling of serotonin from outside the nerve to inside the nerve. This increase in serotonin in the gap between nerves in the central nervous system (the synapse) leads to alterations in serotonin function that have been associated with improvements in depression, anxiety and eating disorders. Each of these serotonin reuptake inhibitors (SSRIs for short) has its own personality, if you will. Fluoxetine is sometimes a bit activating and energizing compared to the other SSRIs.
Fluoxetine is processed for elimination from the body (“metabolized”) in the liver to a compound called norfluoxetine that is also an effective antidepressant and that in turn takes much longer to be eliminated from the body (the half-life of norfluoxetine is about 10 days; that of fluoxetine about one day). This means that effectively fluoxetine takes up to 6 weeks to be eliminated from the body when stopped.
Fluoxetine in combination with a monoamine oxidase inhibitor can cause serotonin syndrome that in turn can be fatal.
Possible adverse effects can include nausea, insomnia, agitation, diarrhea, difficulty thinking and others. Sometimes, in common with other SSRIs, it may leave a person feeling a bit numb emotionally rather than really well and “perky”.
Fluoxetine slows down the rate at which some enzyme systems in the liver eliminate other medications (CYP2D6, 4A2). This can lead to problems if the other medication can cause significant adverse events in higher than usual levels.
Fluoxetine has been associated, along with the other SSRIs, with neonatal pulmonary hypertension in neonates exposed to fluoxetine in the final trimester of pregnancy.
All antidepressants have a warning from the FDA against new onset suicidal “thoughts and behaviors”. There is no evidence children taking antidepressants are suiciding; quite otherwise, there is very good evidence that children treated for depression suicide less often than children who are depressed who are not treated with antidepressants.
If you miss a dose of fluoxetine do not add the missed dose to the next dose. Take the fluoxetine regularly as prescribed.
