How does Prozac affect weight during long-term treatment. What are the factors influencing weight changes in patients using fluoxetine. Can Prozac cause significant weight gain or loss over time. Is weight gain inevitable with prolonged Prozac use. How does appetite relate to weight changes in fluoxetine treatment.

Understanding Fluoxetine’s Impact on Body Weight

Fluoxetine, commonly known by its brand name Prozac, is a widely prescribed antidepressant belonging to the selective serotonin reuptake inhibitor (SSRI) class. While its primary use is in treating depression, there has been considerable interest in understanding its effects on body weight, both in the short and long term.

A comprehensive one-year trial of fluoxetine has shed light on the complex relationship between this medication and weight changes in patients. Let’s delve into the findings and their implications for those using or considering Prozac as part of their treatment regimen.

Initial Weight Loss During Acute Treatment

During the first 12 weeks of treatment, patients experienced a modest weight loss. What was the average weight change observed? The study reported a mean absolute weight decrease of 0.4 kg (approximately 0.88 pounds) within the initial 4 weeks of therapy. This finding suggests that Prozac may have a mild appetite-suppressing effect in the early stages of treatment.

Long-Term Weight Trends

As the study progressed beyond the acute phase, interesting patterns emerged. How did weight change over the course of a year? For patients who completed 50 weeks of therapy, both the placebo and fluoxetine-treated groups showed similar mean absolute weight increases during the continuation treatment. This observation challenges the notion that long-term Prozac use inevitably leads to significant weight gain.

Factors Influencing Weight Changes in Fluoxetine Treatment

Several factors were examined to understand what might influence weight changes in patients using Prozac. These insights can be valuable for both healthcare providers and patients in managing expectations and potential side effects.

Body Mass Index (BMI) and Weight Change

One might assume that a patient’s initial body mass index would predict their likelihood of gaining weight on Prozac. However, the study found no significant relationship between initial BMI and subsequent weight changes. This suggests that a patient’s starting weight may not be a reliable indicator of how their body will respond to fluoxetine in terms of weight fluctuations.

The Role of Appetite in Weight Changes

Appetite emerged as a crucial factor in understanding weight changes during Prozac treatment. The study identified two key relationships:

• Poor appetite at study entry was associated with subsequent weight gain
• Improvement in appetite after recovery from depression was linked to weight increase

These findings highlight the complex interplay between depression, appetite, and weight changes during antidepressant treatment. Is the weight gain observed in some patients due to the medication itself or the resolution of depression-related symptoms? The evidence suggests that the latter may play a significant role.

Prozac and Weight Loss: Separating Fact from Fiction

While much attention is often given to potential weight gain associated with antidepressants, the initial weight loss observed in this study warrants further discussion. Why might Prozac lead to weight loss in the short term?

Fluoxetine’s mechanism of action involves increasing serotonin levels in the brain. Serotonin is known to play a role in appetite regulation and satiety. By enhancing serotonin activity, Prozac may initially reduce appetite in some patients, leading to modest weight loss.

However, it’s crucial to note that this effect appears to be temporary for most individuals. As the body adjusts to the medication and depression symptoms improve, weight tends to stabilize or even increase slightly over time.

Long-Term Weight Stability with Prozac Use

One of the most significant findings of this study is the long-term weight stability observed in patients continuing Prozac treatment. Why is this important? Many patients and healthcare providers worry about substantial weight gain as a side effect of prolonged antidepressant use. This study provides reassuring evidence that, on average, patients taking fluoxetine for extended periods do not experience significantly different weight changes compared to those on placebo.

Implications for Patient Care

These findings have several important implications for the management of patients on long-term fluoxetine treatment:

1. Weight monitoring should be a routine part of follow-up care, but dramatic weight changes are not the norm
2. Patients should be educated about the potential for initial weight loss followed by gradual stabilization
3. Significant weight gain during Prozac treatment may warrant investigation of other factors, such as lifestyle changes or the resolution of depression-related appetite suppression
4. Individual responses may vary, and personalized care remains essential

Prozac and Appetite: A Key Relationship

The study’s findings regarding appetite changes provide valuable insights into the mechanism behind weight fluctuations in patients taking Prozac. How does appetite relate to weight changes during fluoxetine treatment?

Patients who reported poor appetite at the beginning of the study were more likely to experience weight gain as treatment progressed. This suggests that as depression symptoms improve and normal appetite returns, weight gain may occur as a natural consequence of increased food intake.

Furthermore, the association between appetite improvement and weight gain supports the idea that some of the weight changes observed during antidepressant treatment may be more related to the resolution of depression symptoms than to direct effects of the medication.

Managing Appetite Changes

For patients and healthcare providers, understanding this relationship can inform strategies to manage weight during Prozac treatment:

• Regular assessment of appetite changes throughout treatment
• Nutritional counseling to support healthy eating habits as appetite improves
• Encouragement of physical activity to balance potential increases in caloric intake
• Monitoring of weight in the context of overall health and depression recovery

Tolerability and Discontinuation Due to Weight Changes

An important aspect of any long-term medication use is its tolerability and the likelihood of discontinuation due to side effects. In the case of weight changes associated with Prozac, the study provides encouraging data.

How many patients discontinued therapy due to weight gain? Remarkably, the study reported that no patients discontinued therapy because of weight gain. This suggests that the weight changes experienced were generally tolerable and did not significantly impact patients’ willingness to continue treatment.

This finding is particularly noteworthy given the concerns many patients have about potential weight gain with antidepressant use. It underscores the importance of balanced patient education and regular monitoring to address concerns and manage expectations regarding weight changes during Prozac treatment.

Comparing Prozac to Other Antidepressants: Weight Change Profiles

While this study focused specifically on fluoxetine, it’s natural to wonder how Prozac’s weight change profile compares to other commonly prescribed antidepressants. How do different classes of antidepressants affect weight?

Antidepressants vary in their propensity to cause weight changes:

• SSRIs (like Prozac): Generally associated with initial weight loss followed by weight neutrality or modest gain
• SNRIs (e.g., venlafaxine): Similar profile to SSRIs, with some variations among specific medications
• Tricyclic antidepressants: Often associated with more significant weight gain
• MAOIs: Can cause weight gain in some patients
• Bupropion: Unique among antidepressants, often associated with weight loss

It’s important to note that individual responses can vary significantly, and the choice of antidepressant should be based on a comprehensive assessment of a patient’s needs, medical history, and potential side effects.

Prozac’s Unique Position

The findings of this long-term study position Prozac as a relatively weight-neutral option among antidepressants, especially over extended periods of use. This characteristic may make it an attractive choice for patients who are particularly concerned about weight gain as a side effect of antidepressant treatment.

Practical Implications for Patients and Healthcare Providers

The insights gained from this comprehensive study of fluoxetine’s effects on weight have several practical implications for both patients considering or currently using Prozac and the healthcare providers managing their treatment.

For Patients:

• Expect potential modest weight loss in the initial weeks of treatment
• Understand that long-term weight changes are generally minimal and similar to those experienced without medication
• Be aware that improvements in depression symptoms may lead to changes in appetite and eating habits
• Communicate any concerns about weight changes to your healthcare provider
• Focus on overall health and depression management rather than solely on weight changes

For Healthcare Providers:

• Counsel patients on the expected pattern of weight changes with Prozac use
• Monitor weight regularly, but interpret changes in the context of overall depression recovery
• Assess and address appetite changes throughout the course of treatment
• Consider Prozac as a potentially weight-neutral option for patients concerned about antidepressant-related weight gain
• Individualize treatment plans, recognizing that responses may vary among patients

By incorporating these insights into clinical practice and patient education, the management of depression with fluoxetine can be optimized, potentially improving treatment adherence and outcomes.

Future Research Directions in Antidepressants and Weight Management

While this study provides valuable long-term data on fluoxetine and weight changes, it also highlights areas where further research could enhance our understanding and improve patient care.

Potential Areas for Future Investigation:

• Genetic factors influencing individual weight responses to antidepressants
• The role of lifestyle interventions in mitigating weight changes during antidepressant treatment
• Long-term metabolic effects of various antidepressants beyond weight changes
• Strategies to optimize antidepressant choice based on individual patient characteristics and weight change risk
• The impact of combination therapies on weight trajectories in depression treatment

Continued research in these areas could lead to more personalized approaches to antidepressant therapy, potentially improving both efficacy and tolerability for patients struggling with depression.

In conclusion, this comprehensive study of fluoxetine’s effects on weight over a one-year period provides reassuring evidence for the long-term weight neutrality of Prozac. While individual responses may vary, patients and healthcare providers can approach fluoxetine treatment with a clearer understanding of its potential impact on weight, allowing for more informed decision-making and management strategies in the treatment of depression.

Changes in weight during a 1-year trial of fluoxetine

Objective:

Fluoxetine has been associated with weight loss during acute treatment, but no controlled studies of weight change during long-term treatment with fluoxetine or other selective serotonin reuptake inhibitors have been reported. Weights were assessed for patients whose depressive symptoms had disappeared with acute fluoxetine treatment. Patients were then randomly assigned to continuation treatment with fluoxetine or placebo.

Method:

Patients whose illness had remitted after 12 weeks of treatment with fluoxetine, 20 mg/day, were randomly assigned to receive up to 38 weeks of treatment with fluoxetine or placebo. Weight was assessed at each visit. Change in weight was analyzed during the initial 12 weeks of acute treatment and after 14, 26, and 38 weeks. Relationships between weight change and body mass index and between weight change and appetite change were assessed.

Results:

During the initial 4 weeks of therapy, a mean absolute weight decrease of 0.4 kg was observed for all patients. Among patients who completed 50 weeks of therapy, the mean absolute weight increase during continuation treatment was similar for both the placebo- and fluoxetine-treated groups. Weight increase was not related to initial body mass index but was related to both poor appetite at study entry and to improvement in appetite after recovery. No patients discontinued therapy because of weight gain.

Conclusions:

Acute therapy with fluoxetine is associated with modest weight loss. After remission of depressive symptoms, weight gain for patients taking fluoxetine for longer periods is not different from that for patients taking placebo and is most likely related to recovery from depression.

How Prozac Weight Gain and Weight Loss Affects the Body

The medical uses of Prozac include the treatment of health conditions such as obesity and depression. It alleviates depression by preventing serotonin, a mood-stabilizing neurotransmitter, from being reabsorbed by the neurons. It has been shown to help with loss of mass initially, but many people end up putting on pounds. This phenomenon of Prozac weight gain can be one of the unpleasant side effects of Fluoxetine, and turning to a health professional is the best way to cope in this case.

Antidepressant Effects On Weight

Antidepressants are one of the most commonly prescribed drugs in the US, and a common side effect of the drug class is a gain in mass. However, the degree of gain varies among different users and different antidepressants. The mechanism behind this antidepressant side effect is poorly understood but is believed to be due to several mechanisms.

One involves the effect of antidepressants on the neurotransmitter serotonin. Serotonin acts as an appetite suppressant. Therefore, changes in serotonin levels can lead to increased cravings for energy-dense meals, leading to the user eating more frequently. This increased eating frequency may be a possible mechanism between the medication Prozac and weight gain.

Another suspected cause of the size gain associated with using antidepressant drugs besides eating more often is the direct effects of the drugs on metabolism. However, these health effects differ from one drug to another and are often poorly understood, with numerous medical studies being of little help due to contradictory reports.

In certain situations, antidepressant drugs have also been associated with body size loss, such as the commonly noticed Prozac weight loss. Major depressive disorder can cause changes in appetite, which may involve eating more often.

Therefore, individuals who gained mass due to excessive feeding caused by the depressive disorder may notice a drop in body size as the antidepressant drugs return their feeding pattern to normal.

Effects of Depression on Weight

Just as antidepressants have a profound effect on the body, such as the relationship between Prozac and weight gain, so does the mental health disorder itself. Major depressive disorder is a highly complex mental health disorder due to the brain’s complexity and the factors affecting its function. Some individuals who suffer from depression notice an increase in body size, while others notice losing pounds. There are several ways to explain body mass changes associated with conditions such as depression, anxiety, and obsessive-compulsive disorders (OCDs).

The most apparent way depression affects body weight is through changes in appetite and eating patterns, through its interactions with certain hormones involved in regulating appetite, such as the involvement of serotonin in long-term fluoxetine weight loss. Some depressed individuals eat more while others start eating less. In the long run, these can lead to profound changes in body mass.

Another important factor is the effect of specific mental health conditions on physical activity. While depression is classically associated with reduced physical activity, certain subsets such as those associated with anxiety or OCDs can lead to increased physical activity and subsequent loss in mass.

The last factor is the poorly understood effects of depression on the body’s metabolism and overall health. Depression has a profound and varying impact on brain chemistry, which affects the body’s health and metabolism in various ways, leading to changes in body mass. For instance, anxiety is associated with higher levels of circulating catecholamines, which is associated with mass loss.

Prozac Weight Gain

The relationship involved in fluoxetine weight gain is complex. Prozac weight gain can occur if the loss in size occurred due to depression. If the individual gained size due to depression, it might lead to losing pounds as appetite returns to normal. Generally, Prozac weight loss occurs initially, but long-term use may lead to an increase in size. The mechanism involved in Prozac weight gain is still poorly understood.

Certain antidepressants have been closely associated with the gain. For example, comparing Prozac and Zoloft, the latter is more likely to cause weight gain. Others include tricyclic antidepressants (such as amitriptyline, desipramine, imipramine), selective serotonin Reuptake inhibitors (such as citalopram, paroxetine), monoamine oxidase inhibitors (such as phenelzine, isocarboxazid).

Prozac Weight Loss

Prozac (Fluoxetine) is sometimes prescribed as a treatment for obesity. Studies have shown that the use of the antidepressant Prozac can cause an acute loss in weight among those taking the drug to treat major depressive disorders. This may be due to the effect of the drug on serotonin, an appetite suppressant. It may lead to restoration of normal feeding patterns, which are often distorted in depression, making it a good option for overweight or obese individuals who also have depression. However, long-term use is also associated with body mass gain.

A study showed patients on Fluoxetine lost 13 pounds, more than twice as much as those on Xenical (6 pounds) in the same time frame. Likewise, patients taking Fluoxetine for 27 weeks on average lost 11 pounds, compared with less than 10 by patients using Meridia in the same period. It is important to start reducing the dose as appropriate when the drug has been prescribed for obesity.

Experts have not established the relationship between the medication Prozac and weight loss. Still, at any rate, obesity is an independent risk factor linked to the significant increase in mortality and morbidity, and its effective treatment is crucial.

Researchers conclude that Fluoxetine is a safe and effective drug for short-term obesity treatment. However, drinking on Prozac can impede the size reduction process because spirit drinks are usually high in calories. Besides it, this practice is also dangerous. Due to the long Prozac half-life, it stays in the system for an extended period, meaning one needs to wait until it’s fully eliminated from the body before drinking alcohol.

Bringing the Body Back to Normal

Some individuals are dissatisfied with their change in body mass during the use of Prozac, whether mass loss or gain. While there is no quick way to return to your previous body size, options such as a healthy diet, exercise, and other healthy lifestyle habits that encourage a normal return to your previous size can help.

Going Off Fluoxetine: Talk to a Doctor

It is essential to speak with a physician if one wants to stop Prozac, possibly due to Prozac weight gain. A competent doctor will give his or her patient detailed instructions on how to taper off it to avoid withdrawal symptoms like sleeplessness, irritability, dramatic body mass loss or gain, fatigue, headaches, confusion, and vertigo. These symptoms can persist for up to two months.

Apart from causing dramatic body mass gain or loss, Fluoxetine can produce feelings of euphoria that can lead to abuse and addiction. If a person cannot cope with symptoms of withdrawal from Prozac or experiencing sudden body mass changes, getting professional help at a rehab center is crucial. These facilities have experienced medical staff who help people heal in a safe, welcoming environment.

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Page Sources

1. Afkhami-Ardekani, M., & Sedghi, H. (2005). Effect of fluoxetine on weight reduction in obese patients. Indian journal of clinical biochemistry : IJCB, 20(1), 135–138. https://doi.org/10.1007/BF02893059
2. PA Cascade, E., Kalali, A. H., & Kennedy, S. H. (2009). Real-World Data on SSRI Antidepressant Side Effects. Psychiatry (Edgmont (Pa. : Township)), 6(2), 16–18. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719451/
3. Nikhil Nihalani, Thomas L. Schwartz, Umar A. Siddiqui, James L. Megna, “Weight Gain, Obesity, and Psychotropic Prescribing”, Journal of Obesity, vol. 2011, Article ID 893629, 9 pages, 2011. https://doi.org/10.1155/2011/893629
4. Michelson, D., Amsterdam, J. D., Quitkin, F. M., Reimherr, F. W., Rosenbaum, J. F., Zajecka, J., Sundell, K. L., Kim, Y., & Beasley, C. M., Jr (1999). Changes in weight during a 1-year trial of fluoxetine. The American journal of psychiatry, 156(8), 1170–1176. https://doi.org/10.1176/ajp.156.8.1170
5. Harvard Health Publishing, Harvard Medical School, Antidepressants cause minimal weight gain, 2014. https://www.health.harvard.edu/blog/antidepressants-cause-minimal-weight-gain-201406067202
6. Curzon G. (1990). Serotonin and appetite. Annals of the New York Academy of Sciences, 600, 521–531. https://doi.org/10.1111/j.1749-6632.1990.tb16907.x
7. Olguner Eker, Ö., Özsoy, S., Eker, B., & Doğan, H. (2017). Metabolic Effects of Antidepressant Treatment. Noro psikiyatri arsivi, 54(1), 49–56. https://doi.org/10.5152/npa.2016.12373
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9. Billes, S. K., & Cowley, M. A. (2008). Catecholamine reuptake inhibition causes weight loss by increasing locomotor activity and thermogenesis. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology, 33(6), 1287–1297. https://doi.org/10.1038/sj.npp.1301526

Published on: June 27th, 2018

Updated on: April 8th, 2021

Dr. Roger Weiss is a practicing mental health specialist at the hospital. Dr. Weiss combines his clinical practice and medical writing career since 2009. Apart from these activities, Dr. Weiss also delivers lectures for youth, former addicts, and everyone interested in topics such as substance abuse and treatment.

8 years of nursing experience in wide variety of behavioral and addition settings that include adult inpatient and outpatient mental health services with substance use disorders, and geriatric long-term care and hospice care.  He has a particular interest in psychopharmacology, nutritional psychiatry, and alternative treatment options involving particular vitamins, dietary supplements, and administering auricular acupuncture.

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Is Fluoxetine an Effective Therapy for Weight Loss in Obese Patients? – FPIN’s Clinical Inquiries

Clinical Inquiries

FROM THE FAMILY PRACTICE INQUIRIES NETWORK

Searchable Question

In patients who are obese, are selective serotonin reuptake inhibitors (SSRIs) more effective than placebo or other therapies for weight loss?

Evidence-Based Answer

Fluoxetine (Prozac) use may result in an average, short-term weight loss of up to 3.3 kg (7 lb, 4 oz) in obese patients, but the longterm effects and maintenance of weight loss after discontinuation of the drug have not been well studied. No evidence concerning other SSRIs was found. [Strength of recommendation: B, based on low-quality systematic reviews of randomized controlled trials (RCTs)]

Evidence Summary

Safety concerns have curbed the use of many weight loss medications, notably appetite suppressants. SSRIs, initially approved for the treatment of depression, are being studied now for use in obesity treatment.

A systematic review1 of 11 studies of fluoxetine in the treatment of obesity was weakened by a failure to evaluate the quality of the included articles and by its reliance on effect size as a reported outcome. The review did use a reasonably comprehensive search strategy and a sound meta-analytic process. In the 11 studies, fluoxetine was used for an average of 28 weeks and resulted in an average weight loss of 3.3 kg. [Evidence level 2a] No long-term follow-up data were available in this review.

Another review2 reported the same information but noted, in 10 to 15 percent of cases, an occurrence of minor side effects (e.g., anxiety, diarrhea, dry mouth), and “uncommon but serious” adverse events (e. g., bleeding, granulocytopenia, seizures, hyponatremia, hepatotoxicity, serotonin syndrome, extrapyramidal effects). [Evidence level 2a]

A 1999 systematic review3 of RCTs and prospective cohort trials looked at existing treatment options for obesity. A single RCT of fluoxetine was included in the review of eight RCTs of drug therapy in combination with dietary management and appetite suppressants. Fluoxetine had no significant benefit over placebo in bringing about weight loss in the 12-month study. All of the RCTs reported that any weight lost with medication use generally was regained 12 months after discontinuation of therapy. [Evidence level 1a: systematic review]

The Agency for Health Care Research and Quality is preparing a health technology assessment on the topic of pharmacologic therapy for obesity.

Recommendations from Others

The Obesity Education Initiative guidelines4 from the National Heart, Lung, and Blood Institute do not address SSRIs in the pharmacologic management of obesity, presumably because SSRIs are not approved by the U. S. Food and Drug Administration for this use. [Evidence level 5: evidence-linked consensus guideline]

Clinical Commentary

One of the consistent “concomitant therapies” in all pharmacologic weight loss studies is a program of rigorous diet and exercise. Evaluating SSRIs as weight loss therapy is a good idea, given the extent of obesity in our society. However, as safer weight loss medications are brought to the market, we must resist the temptation to concentrate solely on the numbers on the scale and continue to promote a healthy lifestyle of diet and exercise as the primary method of achieving weight control and preventing obesity.

Losing Weight on Prozac | Livestrong.com

Image Credit: Prostock-Studio/iStock/GettyImages

The Prozac story began in 1987, when the Eli Lilly pharmaceutical corporation released a drug aimed at fighting depression. The drug, whose trademark name is fluoxetine, had an unexpected, but serendipitous side-effect. Unlike other antidepressants, which often cause weight gain, some patients reported minor and significant weight loss from taking Prozac.

Prozac belongs to the selective serotonin reuptake inhibitor family of antidepressants, explains Mayoclinic.com. These drugs influence the brain’s chemical messengers, called neurotransmitters. Serotonin is a neurotransmitter associated with mood, sleep and appetite. After a nerve cell releases serotonin, a uptake pump re-absorbs some of it into the brain. A serotonin reuptake inhibitor prevents the re-absorption of serotonin, keeping it more available on an ongoing basis. Since serotonin helps control appetite, normalizing its levels might eventually lead to weight loss.

The word satiety refers to after-meal feelings of fullness. Researchers at the Department of Psychology, School of Medicine at University of Leeds, UK speculated that Prozac causes weight loss by increasing post-meal satiety. They recruited 12 non-depressed females with obesity to test their theories. During the two-week experiment, one group took 60 mg of Prozac, while the control group took a placebo. The subjects taking Prozac consumed an average of 532 during a meal. In contrast, the control group consumed 730 calories. The Prozac group lost about 4.4 lbs. during the two-week period, whereas the control group only lost 0.8 lb. Lead author C.L. Lawton published the study in the 1995 edition of “Obesity Research.”

The serotonin inhibitor theory of why Prozac controls appetite is certainly logical, but there is one significant caveat. Researchers at Massachusetts General Hospital in Boston found that Paxil and Zoloft, which are brands of selective serotonin reuptake inhibitors, may actually cause weight gain. Lead author M. Fava randomly assigned patients to Prozac, Paxil or Zoloft treatment. After 32 weeks of treatment, the Paxil and Zoloft patients showed minor to significant weight gain, whereas the Prozac patients showed weight loss. The “Journal of Clinical Psychiatry” published the study in November 2000.

Prozac and Baseline Weight

Researchers at Mclean Hospital in Belmont Massachusetts speculated that Prozac weight loss is a function of the patient’s baseline weight. They tested depressed patients over a six-month period. Each patient took between 20 and 80 mg of Prozac. Lead author M.H. Orzack reported that while all subjects experienced decreased depression, patients who had overweight were the only ones who lost weight. Patients at their ideal weight actually gained an average of 4.4 lbs., while underweight patients did not show any significant trends. “Psychopharmocology Bulletin” published the study in 1990.

Why Is It So Hard to Lose Weight After Antidepressants?

Side effects from medications are common, although usually not severe enough to halt treatment. Anyone who has listened, perhaps unwillingly, to the recital of side effects on a television commercial for a medication is aware of the number of health problems that might arise while taking that particular drug. But unless the side effect is death, one assumes that most of these adverse events go away once the medication is no longer taken.

Weight gain is a common side effect associated with many medications prescribed for depression, and/or anxiety, or the pain of fibromyalgia. We know that the weight is gained for the same reason weight is usually gained: More calories are consumed than needed by the body for energy. But even though most of the people gaining weight as a side effect of antidepressants and related medications may become overweight, they differ from the typical overweight or obese individual. The latter typically struggle with their weight because of a lifestyle of eating too much, exercising too little, and in many cases using food to deflect emotional issues. But people whose obesity is a side effect of their medication may never have had a problem maintaining a normal weight prior to their treatment. To them, gaining weight was as much of a shock and disruption to their body as losing hair is to a patient on chemotherapy.

They’d never dieted. Why would they? They never needed to

Antidepressants, mood stabilizers, and atypical antipsychotic drugs seem to alter appetite by inhibiting serotonin-based regulation of the appetite function. A persistent need to eat remains after the stomach is full of food, along with cravings for carbohydrate snacks. Sometimes the need to eat interferes with sleep, and leads to waking up in the middle of the night. Medication-associated fatigue frequently accompanies the overeating side effects, so the motivation, and indeed the ability, to work the extra calories off through exercise becomes difficult or impossible.

All of this is well known, and even if a prescribing physician may not mention weight gain as a side effect, countless studies have confirmed it to be so.

So if weight gain is caused by the medication, then weight loss should follow its discontinuation. And it does, for many people: Once the medication is out of the body, normal appetite returns, fatigue diminishes, and the patient returns to eating and exercising normally. Increasing serotonin level and activity prior to meals diminishes any lingering inability to feel full after eating or to control snacking. Consuming small amounts of fat-free, low-protein carbohydrate foods such as oatmeal an hour before mealtime or as an afternoon snack increases serotonin sufficiently to resume normal appetite control. Returning to a vigorous workout schedule once the side effect of fatigue disappears accelerates weight loss.

But not everyone is able to lose the weight even months after the medication is stopped — and no one knows why.

Formerly fit individuals are horrified to find that the 15, 25, or 50 pounds they gained on their medication is hanging around like a relative who won’t quit the guest room. Diets are tried and discarded for lack of success. Aerobic and strength-training workouts are increased in frequency and duration. Yet the pounds stay on.

The result can be feelings of despair and desperation. It is as if someone who loses her hair while undergoing chemotherapy learns that she will be bald for the rest of her life. Patients who have become obese due to their medication believe their bodies will be permanently changed. They believe they will never return to the bodies they had before their medications, and grudgingly and often angrily resign themselves to accept being overweight or obese.

Some suggest that water retention may be responsible for the increased weight, but once the medication is out of the body, the excess water should be lost. Others point to some muscle loss before and during the early stages of treatment, when depression had led to weeks of inactivity. However, rebuilding muscle mass doesn’t seem to produce any significant weight loss. It is possible that metabolic rate decreased as a result of treatment, and therefore is slowing weight loss. But studies on thyroid function in patients treated with Zoloft or Prozac did not show any functional change in thyroid hormones.

So at this point, there is little to offer someone who has tried to lose the medication-associated weight by dieting and exercising, and is failing.

Is the weight finally lost, many months or even years after the antidepressants or related drugs are out of the body? Are the extra pounds still attached to the body five or ten years later? No one knows. There are no long-term studies following patients after they discontinue treatment to see if weight is lost and, if so, what produced the weight loss. Interestingly, there are many studies showing that after a weight-loss diet is over, people’s weight eventually returns to the heavier pre-diet weight or “set-point.” Perhaps it is time to see whether people whose weight gain is a consequence of antidepressant treatment will also return to their own set-point.

Prozac vs. Paxil? All you need to know about SSRIs

By Dr. Aneel Ursani, 07/01/2020

Have you ever wondered why you or others receive different antidepressant medications? Depression affects people in unique ways—it’s rarely the same across individuals. Some of us might feel more fatigue and low energy, others might be having difficulty falling asleep. Because our bodies are distinct, so too is our treatment.

So what are Paxil (Paroxetine) and Prozac (Fluoxetine)? If you’ve ever looked into antidepressants, you might have come across both of these prescription medications. Paxil and Prozac are both selective serotonin reuptake inhibitors (SSRIs). In this post, we’ll explore their similarities, differences, possible side effects, and proper usage.

What are SSRIs?

SSRIs are antidepressants that treat both anxiety and depression by increasing serotonin levels in your brain. Serotonin is one type of chemical known as a “neurotransmitter” that transmits messages along certain pathways in the brain. It is a “feel-good chemical” that contributes to our feelings of well-being as well as having many other effects on our mood, appetite, and sleep-wake cycle.

Because SSRIs increase the levels of serotonin in the brain, it allows the brain to transmit messages related to feeling good more easily. The effects are improved energy, a more positive mood, and less depressed thinking patterns. SSRIs may take a few weeks to take full effect.

How are Prozac and Paxil different?

Both SSRIs have shown comparable success in treating depression, though Paxil has a higher response rate and takes effect sooner than Prozac. The greatest differences between the two SSRIs are in how each one is used and what the side effects are.

In addition to depression, Paxil is FDA approved to treat anxiety disorders (both social anxiety disorder and generalized anxiety disorder) and post-traumatic stress disorder (PTSD). Prozac is approved for depression, obsessive-compulsive disorder, and panic disorder, and is used off-label to treat anxiety and PTSD. Prozac is also sometimes used to treat bulimia.

What are the advantages of Prozac over Paxil?

Prozac is FDA approved for children eight or older. It also has a weaker potency as a serotonin inhibitor, which means it has less noticeable symptoms upon discontinuation than Paxil and many other antidepressants.

One of the major upsides of Prozac is that it seems to work better for patients with fatigue or low energy since it has a greater energizing effect than other antidepressants. However, this might not be a great option for those who have sleep difficulties. Make sure to let your provider know if you often feel fatigued or low energy when deciding a course of treatment.

What are the advantages of Paxil over Prozac?

Paxil is available for those who are 18 and up. It’s one of the more potent SSRIs and doesn’t have as many stimulating effects as some other medication, which means it can be taken at bedtime.

For those with a combination of depression, insomnia, and hyperarousal symptoms, Paxil may work better than Prozac. If you find yourself with this combination of symptoms, it may be worthwhile to bring it up with your provider for treatment.

What are the side effects of these medications?

In addition to the side effects previously mentioned, long-term SSRI use may lead to various side effects including weight fluctuations, sexual dysfunction, and nausea.

With Paxil, side effects may include constipation, indigestion, tremor, sweating, and muscle pain. As Prozac is a more stimulating antidepressant, it is more likely to cause insomnia and usually taken in the morning or afternoon rather than at night. Prozac may lead to greater nervousness and weight loss. Paxil, on the other hand, is more likely to cause weight gain. These are the common side effects, though not a comprehensive list.

What are the drug warnings of Paxil and Prozac?

If an individual is suicidal to begin with, he or she may be at a greater risk of suicide before the SSRI takes full effect. The reason is that SSRIs often improve energy first and then take a little longer to lessen depressed mood and thinking. When a person’s depression starts to lift and energy starts to return, he or she may feel less hopeless and helpless but still feel depressed. This doesn’t necessarily mean that the medicine is making someone want to harm him/herself. Those who are already thinking of harming themselves may think about suicide as a way out, whereas before they were too immobilized to make a specific plan.

As such, their usage needs to be monitored. Taking either drug may trigger manic episodes for those with bipolar disorder and withdrawal symptoms if not discontinued properly.

Pregnant women should not use Paxil and only use Prozac if the benefits outweigh the risks. Both antidepressants should not be used with alcohol since it can increase drowsiness or dizziness.

What are the drug interactions of Paxil and Prozac?

When taking either antidepressant, it’s important to be cautious of drug interactions. Both interact with monoamine oxidase inhibitors (MAOIs) such as selegiline and phenelzine. MAOI use must be discontinued 14 days before starting an SSRI.

The consequences of taking these together may increase the risk of serotonin syndrome, which may cause fever, agitation, and diarrhea. It is also recommended that Prozac and Paxil are taken independent of pimozide or thioridazine–taking them together may lead to an increased risk of QT prolongation or abnormal heart rhythm.

Prozac and Paxil may also interact with benzodiazepines, anticonvulsants, opioids, NSAIDs, and other blood thinners. Please note that this list is not comprehensive.

—

We hope this guide provides some insight into the similarities and differences between Paxil and Prozac. Ultimately, it is important to consult your prescribing provider to find the medication that best suits your needs and medical history.

9 Prozac Side Effects – Antidepressant Side Effects

Prozac was so popular after its debut in 1988 that it inspired not one but two best-selling books: Listening to Prozac and Prozac Nation (which was turned into a movie starring Christina Ricci).

It was the first SSRI, or selective-serotonin reuptake inhibitor, approved by the Federal Drug Administration, and 20 later, Prozac is still one of the top five psychiatric drugs prescribed to American adults dealing with depression and anxiety.

While most SSRIs are safe and easily tolerated, they are still psychoactive drugs—so yes, there are Prozac side effects you should know about.

Prozac stays in your system for one to two weeks, says Alison Hermann, M.D., a clinical psychiatrist at Weill Cornell Medicine and New York-Presbyterian Hospital. Which means: “If you’re someone who forgets to take your meds every day, that’s great, says Hermann. “If you’re having side effects, that can make things extra difficult.”

This content is imported from Giphy. You may be able to find the same content in another format, or you may be able to find more information, at their web site.

If you decide to try Prozac to manage your depression or anxiety, keep an eye out for these side effects.

1. GI Distress

“By far, the most common Prozac side effects are gastrointestinal, mostly nausea and diarrhea,” says Hermann. Fun fact: “There are actually more cells that have serotonin receptors on them in your gut than there are in the brain, and since Prozac works on the serotonin system, that area can be sensitive to having more serotonin around.” These side effects tend to occur early on in treatment, and can be minimized by starting with a low dose or taking the meds with food.

2. Changes in Arousal

No, we’re not talking about sex—yet. “Some people taking an SSRI for the first time may feel tired or a bit sedated initially, or the opposite, a little revved up or jittery,” says Murrough. “It basically occurs as the neurotransmitters in the brain get used to being exposed to something new.” Again, starting on a low dose can help mitigate this side effect.

“With serotonin syndrome, you would have symptoms like fever, agitation, increased reflexes, tremors, and you’d likely have to go to the emergency room.”

3. Suicidal Thinking

Antidepressants and anti-anxiety medications are meant to help you feel better, but in some people, they can actually increase depressive thoughts. “The FDA has issued a black box warning—its strictest warning—that antidepressants can actually increase suicidal thinking in young adults and children,” says Murrough. Yes, it’s rare, but if you’re going to the doctor for depression and the medication makes you feel worse, you should absolutely talk to your doc ASAP.

4. Sexual Side Effects

These side effects tend to present once you’re on a stable dose—and the higher the dose, the more likely you are to experience them. “It can run the gamut, whether you’re a man or a woman: decreased libido, decreased genital sensations, impotence, or difficulty having an orgasm,” says Hermann. “We’re not quite sure why this happens, and anxiety and depression affect sexual functioning and sexual interest, so it can be difficult to figure out if it’s the mental disorder or the medication to blame.” Still, talk to your doc if your sex drive takes a dive.

5. Serotonin Syndrome

This is a rare side effects of medications that work on serotonin, like Prozac, but can occur if you’re on more than one drug that affects serotonin levels—which can overload your system. “With serotonin syndrome, you would have symptoms like fever, agitation, increased reflexes, tremors, sweating, dilated pupils, and diarrhea, and you’d likely have to go to the emergency room,” says Hermann.

6. Changes in Weight or Appetite

A study published in the journal JAMA Psychiatry found that people taking Prozac gained an average of a pound and a half over the course of a year of taking the medication.

If you notice more bruises than normal or cuts that won’t stop bleeding, definitely bring that to your doctor’s attention.

7. Low Sodium Levels

“When you’re on any SSRIs, the medication can cause your kidneys to excrete more sodium,” says Hermann. “That can lead to symptoms like headaches, confusion, slurred speech, and general weakness.” She recommends that anyone taking antidepressants or anti-anxiety drugs have at least yearly blood work done to check electrolyte levels.

8. Trouble Sleeping

Like most SSRIs, Prozac can have an effect on sleep quality. “Any time you take a medication that affects the brain, there’s a potential for alterations in arousal,” says Murrough. That can manifest in abnormal dreams, difficulty falling or staying asleep, or even nighttime sweats.

9. Increased or Unusual Bruising or Bleeding

“SSRIs can affect the way platelets aggregate to stop bleeding in some people,” says Murrough. This is almost nonexistent in the general population, but there is a risk of bleeding more easily while taking Prozac. This would be most likely to occur in older patients, says Murrough—but if you notice more bruises than normal or cuts that won’t stop bleeding, definitely bring that to your doctor’s attention.

Ashley Mateo
Ashley Mateo is a writer, editor, and UESCA- and RRCA-certified running coach who has contributed to Runner’s World, Bicycling, Women’s Health, Health, Shape, Self, and more.

This content is created and maintained by a third party, and imported onto this page to help users provide their email addresses. You may be able to find more information about this and similar content at piano.io

90,000 Fluoxetine for overweight or obese adults

Review question

What are the effects of fluoxetine treatment in overweight or obese adults?

Relevance

Fluoxetine is a medication used to treat depression that reduces appetite as a side effect. In this regard, there is a suspicion that fluoxetine may be used as a treatment option for people who are overweight or obese.In this group of people, prescribing fluoxetine means treatment for an unregistered indication, that is, fluoxetine is not licensed (approved) for the treatment of obesity.

Research characteristics

We found 19 randomized controlled trials (clinical trials in which people are randomly assigned to one of two or more treatment groups) that evaluated mainly women who received different doses of fluoxetine. A total of 1,280 overweight or obese participants received fluoxetine and 936 participants received mostly placebo or other anti-obesity medication.Participants in the included studies were followed for periods ranging from three weeks to one year.

Highlights

For our main comparison group – fluoxetine versus placebo – and for all doses of fluoxetine, weight loss was 2.7 kg in favor of fluoxetine. We are not sure, however, that additional research will re-demonstrate the benefits of fluoxetine. A total of 399 of 627 participants (63.6%) who received fluoxetine, compared with 352 of 626 participants (56.2%) who received placebo, experienced side effects.Dizziness, drowsiness, fatigue, insomnia and nausea were observed about twice as often after [taking] fluoxetine compared with placebo. A total of 15 of 197 participants (7.6%) who received fluoxetine, compared with 12 of 196 participants (6.1%) who received a placebo, experienced depression. The studies did not report death from any cause, health-related quality of life, and socioeconomic effects.

This evidence is current to December 2018.

Certainty of evidence

The overall certainty of the evidence was low or very low, mainly due to the small number of studies that measured outcomes and the small number of participants.

45 reviews, instructions for use

When used simultaneously with drugs that have a depressing effect on the central nervous system, with ethanol, a significant increase in the inhibitory effect on the central nervous system is possible, as well as an increase in the likelihood of seizures.

With simultaneous use with MAO inhibitors, furazolidone, procarbazine, tryptophan, the development of serotonin syndrome is possible (confusion, hypomania, motor restlessness, agitation, convulsions, dysarthria, hypertensive crisis, chills, tremor, nausea, vomiting), vomiting,

With the simultaneous use of fluoxetine inhibits the metabolism of tricyclic and tetracyclic antidepressants, trazodone, carbamazepine, diazepam, metoprolol, terfenadine, phenytoin, which leads to an increase in their concentration in the blood serum, an increase in their therapeutic and side effects.

With simultaneous use, it is possible to inhibit the biotransformation of drugs metabolized with the participation of the isoenzyme CYP2D6.

With simultaneous use with hypoglycemic agents, their effect may be enhanced.

There are reports of increased effects of warfarin when used simultaneously with fluoxetine.

With simultaneous use with haloperidol, fluphenazine, maprotiline, metoclopramide, perphenazine, periciazine, pimozide, risperidone, sulpiride, trifluoperazine, cases of extrapyramidal symptoms and dystonia have been described; with dextromethorphan – a case of the development of hallucinations has been described; with digoxin – a case of an increase in the concentration of digoxin in the blood plasma.

With simultaneous use with lithium salts, it is possible to increase or decrease the concentration of lithium in the blood plasma.

With simultaneous use, it is possible to increase the concentration of imipramine or desipramine in blood plasma by 2-10 times (it can persist for 3 weeks after discontinuation of fluoxetine).

With simultaneous use with propofol, a case has been described in which spontaneous movements were observed; with phenylpropanolamine – a case was described in which dizziness, weight loss, hyperactivity were observed.

With simultaneous use, it is possible to enhance the effects of flecainide, mexiletine, propafenone, thioridazine, zuclopenthixol.

Fluoxetine for weight loss: be careful, danger!

There are a huge variety of radical ways to lose weight, and most of them are incorrect and frankly unsafe. Many girls try to lose weight with a variety of medications such as fluoxetine.

Even if you were recommended to try this method – forget about it! Fluoxetine for weight loss is not only bad, but also dangerous, and in this article we will tell you why.

What is fluoxetine

Fluoxetine is a drug produced in the form of hard and opaque capsules, which come in different types. And it is used to treat eating disorders (anorexia and bulimia), depression, schizophrenia, and several other mental disorders.

This medicine is sold only with a prescription, and therefore if the pharmacy is ready to sell it to you without a prescription, it is a crime!

How fluoxetine works

Fluoxetine interferes with the seizure of serotonin: it eliminates anxiety, fear, depression, and also – reduces appetite.Due to this quality, they often try to use the drug when they want to radically lose weight.

However, we emphasize: no doctor in his right mind will prescribe fluoxetine for you in order to lose weight.

And this is not because doctors are evil scoundrels standing between you and an ideal figure.

Side effects of fluoxetine

This drug is used by doctors in extreme cases, mainly because of the mass of side effects that can certainly begin with the user of fluoxetine.This drug affects several systems of the human body at once and this can cause major troubles.

Central nervous system:

• severe headaches and dizziness;
• hallucinations and nightmares during sleep, constant restlessness;
• attention disorder, emotional instability;
• tinnitus, fatigue;
• conjunctivitis, loss of visual acuity.

Cardiovascular system:

• anemia;
• leukocytosis;
• ischemic heart disease;
• thrombus formation;
• myocardial infarction;
• tachycardia;
• cardiac arrest.

Respiratory system:

• hiccups and coughs;
• hypoxia, runny nose;
• edema of the lungs, larynx or nasal cavity;
• chest pains.

Gastrointestinal tract:

• dry mouth or vice versa – excessive salivation;
• diarrhea or vice versa – constipation;
• flatulence, pancreatitis, gastritis, stomach or duodenal ulcer;
• nausea;
• internal gastrointestinal bleeding.

An overdose of fluoxetine is also extremely dangerous, because it can cause such ailments as diabetes mellitus, hypoclemia, furunculosis, severe menstrual pain, skin ulcers or acne, eczema, rashes and many others. And, of course, you can die.

Who shouldn’t take fluoxetine

Moreover, not everyone can take fluoxetine. To be honest, this drug is taken only for certain mental problems, and not in order to fit into smaller pants.

No fluoxetine:

• if there is no indication for taking it;
• if there is an individual intolerance;
• if there is renal and hepatic impairment;
• for epilepsy, diabetes mellitus, Parkinson’s disease;
• with a tendency to suicide and during a period of physical exhaustion;
• during pregnancy and lactation;
• up to 18 years old – in no case is it possible;
• for lactose intolerance.

Taking fluoxetine

If indicated, fluoxetine is taken daily and exclusively under the supervision of a doctor! The minimum course of its use is three weeks, but only a specialist can prescribe the correct, minimally dangerous dosage!

Opinions from the forums

Many users are also radically opposed to this method of losing weight:

“Flu.I drank it, a terrible thing. Only as prescribed by a doctor for depression, there are diets for everything else. 7-8 kg per month is very easy if you want. Although it depends on how old you are and whether there was a childbirth. Personally, I ruined my psyche and then really had to be treated by a psychiatrist. Appetite really disappears, there are results, but addiction. More reliable in the old fashioned way ”,

– writes one of the users of the women’s forum when asked about fluoxetine.

Another girl who tried to lose weight using this tool is unsubscribed below:

“I had terrible side effects from him, read the instructions.Many people have a roof on it, depression worsens, thoughts of suicide appear (and not trawling, even the instructions say this). want to be thin and sick? Drink flu. ”

Users also emphasize that antidepressants are not just pills, and that they are bad jokes:

“Antidepressants are not tea with honey. And you need to drink them when it’s not just depression, but the somatics are connected. Trust me, you will understand that these are not toys. That you didn’t add worms? You will also lose weight. “

Many people talk about terrible side effects:

“I drank 1 tablet for a week in the morning. With horror, she dropped the case. Heart aches, anxiety, heavy sleep. The depression almost started. That’s it, that first of all it is an antidepressant. For healthy people, taking this drug is fraught with consequences. Weight loss is a side effect of this drug if you are taking it for depression. ”

We do not recommend taking any medications without permission, without a doctor’s prescription! We also emphasize that prescription drugs are not sold to just anyone for a reason! There is no magic pill that will immediately take and do well, and therefore choose only healthy and correct ways to lose weight and consult your doctor!

Photo: Freepik

The editorial opinion may not coincide with the opinion of the author of the article.

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What are fat burning products for weight loss at home?

Reduslim differs from many pharmaceutical preparations, it has a natural composition.It is safe for the body and rarely causes allergic reactions.

The effect of using fat burning products for weight loss at home

According to doctors, accelerated weight loss when taking Reduslim does not harm the body, since it receives the necessary nutrition from natural ingredients that make up the anti-obesity agent. In addition, blood purification, acceleration of blood and lymph microcirculation, leading to the normalization of water balance and a decrease in puffiness, is noted.

Expert opinion

Perfectly balanced formula of the drug to combat overweight Reduslim helps to get rid of obesity of any degree, regardless of age and gender. The absence of side reactions makes it possible for people with chronic diseases. You can order a slimming product at a low price in rubles and with proven effectiveness only on the online page of the manufacturer or its official representatives.Here they read reviews of real buyers and the results of the use of tablets, comments and recommendations of specialists in the field of nutrition.

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Customer Reviews:

Marina

Reduslim diet pills begin to work 12 hours after administration. Already on the second day, losing weight notes a dulling of appetite, and the results are visible after 3-4 days of use. According to the reviews of those who are losing weight in a month, you can lose up to 15 kg. fat without additional visits to a fitness club or food restrictions. If a person leads an active lifestyle and, at the same time as taking the drug, goes in for sports and switches to a healthy diet, then in a month they get rid of 12-15 kg.

Masha

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Once in my life I tried Reduslim tablets on myself. They are effective after childbirth, work like a Swiss watch, without side effects and helped me lose 8 kg of excess weight in two weeks.In addition to taking medication, I went in for sports and followed a diet. Where to buy fat burning products for weight loss at home? The ideally balanced formula of the drug to combat overweight Reduslim helps to get rid of obesity of any degree, regardless of age and gender. The absence of side reactions makes it possible for people with chronic diseases. You can order a slimming product at a low price in rubles and with proven effectiveness only on the online page of the manufacturer or its official representatives.Here they read reviews of real buyers and the results of the use of tablets, comments and recommendations of specialists in the field of nutrition.

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The best antidepressant, weight loss, energy and drug in one bottle! Good evening! Hello dear ladies and gentlemen! Friday! The capital show Pole Miracles is on the air! 78. Scientists believe that this is a complex of biological processes that occur in the human body as a result of the production of an amphetamine-like substance – phenylethylamine, which is a soft drug. Scientists believe that this is a complex of biological processes that occur in the human body as a result of the production of an amphetamine-like substance – phenylethylamine, which is a soft drug.Can you buy antidepressants without a prescription? What mood enhancers are most effective, when lighter drugs help, and when powerful drugs are needed, how do they work on the body. Despite serious side effects, the creation of weight loss products continues. … Only good should be in moderation, and you should not give up food at all, only a small negative energy balance is needed. The most effective way, according to doctors, are. The problem of being overweight for women is sometimes very serious.And often they use any means to achieve the goal. Many people recommend taking antidepressants for weight loss. Advantages of psychotropic drugs: Antidepressants have a more favorable tolerance profile. … I would never have thought that psychotropic drugs can have a positive effect on weight loss. In the fight against excess pounds, all means are good. … What are antidepressants. Drugs for the treatment of depression, anxiety. Fluoxetine for weight loss. When talking about antidepressants for weight loss, they often mean the drug flu – fluxetin (Prozac).He belongs to the group. The drug has a good antidepressant effect, however. … The drug is an analogue of “Ciprolex”, but cheaper, mild antidepressant, balanced action, few side effects in case of abrupt withdrawal of the drug, there were no cases of overdose, it goes well with the day. reviews about the selector (17). Antidepressants for weight loss have side effects such as insomnia, fatigue, suicidal tendencies, and headaches. They are able to alter metabolism, leading to weight gain.How do I find the best antidepressants? List of the best herbal antidepressants. … Any of the most powerful antidepressants, incl. the safest antidepressants are inherently psychotropic drugs, which. Well, tramadol, venlafaxine, duloxetine, mirtazapine, mianserin, clomipramine are either potent drugs or psychotropic drugs, i.e. not drugs and not prohibited. So I have substance abuse? If I want to achieve a certain feeling of happiness through drugs? The concurrent use of energy drinks and certain antidepressants, such as selective serotonin reuptake inhibitors, can cause pupil dilation in a person.In short, antidepressants are drugs. Antidepressants, like drugs and alcohol, are addictive to them, because. Therefore, if you are not very depressed, it is best not to take antidepressants at all. Antidepressant Zoloft – application, reviews, narcotic effect. Sertraline, leading to accumulation of serotonin in synaptic clefts. This leads to increased neuronal activity and subsequent improvement in mood. For example, drugs such as zoloft are.

Why did the doctor prescribe Fluoxetine for me?

The long-term experience of the specialists of the Clinic for Eating Behavior Disorders proves the effectiveness of the treatment of anorexia, bulimia and binge eating disorder without the use of antidepressants and tranquilizers.Foreign colleagues have long been talking about the futility of drug treatment. However, Russian doctors, psychiatrists and psychotherapists continue to prescribe fluoxetine (Prozac) to food addicts with the same persistence.

Fluoxetine is not at all a drug for reducing appetite and weight, it is a potent antidepressant that can be prescribed by a doctor if the patient has mental disorders.

A doctor may prescribe a drug due to the erroneous opinion that a sharp increase or, on the contrary, a decrease in appetite is one of the complications caused by a mental disorder, such as schizophrenia.

As a result, a potent antidepressant is prescribed to a patient without mental pathologies, and only worsens the patient’s condition, since it does not affect the cause of increased or decreased appetite. Taking Fluoxetine is accompanied by apathy, lethargy, headaches, noise and pain in the ears, diarrhea, nausea, insomnia, impaired taste, pronounced indifference to what is happening. Indifference to the world around you can cause a decrease in appetite during the period of taking the drug, but it will not relieve you of the problem forever.

Fluoxetine, along with Sibutramine, Reduxin, Remantadine and other similar drugs, are considered appetite suppressants (anorexigenic drugs) and thus contribute to weight loss. All of these drugs act in approximately the same way: they affect the central nervous system, disrupt the reverse neuronal uptake of norepinephrine and serotonin, and thus inhibit the hunger center and stimulate the satiety center. All of them are addictive, and do not solve the problem of bulimia, binge eating disorder and excess weight, but rather exacerbate it.Since, when refusing these drugs, the food addict feels the symptoms of the disease with renewed vigor.

Unfortunately, psychiatrists and psychotherapists, who have been prescribing antidepressants to patients with food addiction for centuries, often do not even want to hear about other more effective methods of treatment. Old-school doctors are coldly greeted by the news of the successful experience of treating bulimia, anorexia and binge eating disorder without antidepressants and tranquilizers.One can only guess about the reasons for such adherence to drug treatment.

It’s no secret to many that fluoxetine is a prescription drug, but demand always creates supply. The specialists of our Clinic were themselves among food addicts and tried antidepressant treatment, therefore they strongly recommend not to try to find a “pill for all diseases”, not to aggravate your condition of taking medications, especially without a doctor’s prescription.

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6 drugs that lead to weight gain! What if you don’t lose weight because of this?

Each medicine has its own side effects. Often they are not too serious, and besides, they are temporary – in a word, you can survive. But there are also such medications, the adoption of which is fraught with extremely unpleasant pitfalls. For example, weight gain. Or the retention of already existing extra pounds.Then all your gym and diet efforts will be zero. Nothing personal, as they say, just a side effect. So what do you need to be careful with? Let’s figure it out!

1. Antidepressants

The fact is that antidepressants contain the so-called SSRI (Selective Serotonin Reuptake Inhibitor). Popular drugs in this category include Prozac, Lexapro, Paxil and Zoloft. This very SSRI improves well-being, but at the same time increases appetite and, as a result, patients who take them feel a strong craving for carbohydrates.

Read also

How to quit smoking at home without drugs

What to do: Talk to your doctor about switching to antidepressants with less severe side effects. These include Wellbutrin or Bupropion. This drug even works for weight loss, which will be a great bonus for overweight people.

2. Contraceptive

Oral contraceptives change hormonal levels and therefore often provoke weight gain.And the hormone progesterone, which is part of their composition, makes us feel an increased appetite.

What to do: Today on the drug market there are plenty to choose from, and if you are prone to weight gain, go to an endocrinologist and find the drug that will have the least effect.

3. Beta-blockers

This group of drugs is used to manage heart failure and prevent migraines. On average, people who take them put on between 2 and 3 kg.The problem is that this group of drugs slows down the metabolism and, in the long term, can cause obesity.

Read also

Anxiety, food and excess weight: how to get rid of hyper control and become slimmer?

What to do: The first thing that is prescribed for pressure is diuretics, and if you have been prescribed beta-blockers, then the previous group of drugs does not work. In this case, they are your only way to deal with hypertension. All you can do to keep from gaining weight is to be as active as possible, get enough sleep and eat well.This will keep metabolic processes at a level.

4. Steroids

Side effects from taking steroids:

• insomnia;
• increased appetite;
• water retention in the body.

All three factors can “help” you gain weight in no time. At the same time, 75% of patients taking steroids recover.

What to do: Ask your doctor to reduce the dosage as much as possible. In the meantime, take your medication, follow a simple rule: avoid sitting in front of screens a couple of hours before bed to rule out the possibility of insomnia.

Read also

What to do if you don’t want sex: reasons and advice

5. Antihistamines

Antihistamines are indicated for allergies and allergic reactions. But before taking them, think twice: they often cause weight gain, especially in women. The reason is that these drugs block the production of histamine and, as a result, exacerbate feelings of hunger.

What to do: Try alternative methods of dealing with allergies: Neti pot for rinsing the nose, use of the flavonoid quercetin as a supplement.There are also popular recipes for allergies, which can be a substitute for antihistamines.

6. Antimigraine drugs

It turns out that a group of drugs for headaches can also cause weight gain.

What to do: Find the causes of headaches. They can be caused by lack of sleep, bad habits, unhealthy diet, even insufficient water intake. And sometimes the problem lies in ourselves, and the headache may not be a physiological problem, but an emotional block.

Read also

How to lose weight in 3 days without diets and pills

Based on materials from: prevention.com

Original article: https://www.nur.kz/health/healthcare/1243936-6-lekarstv/

Fluoxetine (Prozac) [LifeBio.wiki]

Fluoxetine molecule

Fluoxetine (also known under the trade names Prozac, Sarafem, Fontex, etc.)) Is an antidepressant of the class of selective serotonin reuptake inhibitors (SSRIs). Fluoxetine was first registered in 1974 by scientists at Eli Lilly and Company. In February 1977, the drug was submitted to the US FDA, and in December 1987, Eli Lilly received final approval to market the drug. In August 2001, the patent for Fluoxetine expired.
Fluoxetine is approved for the treatment of major depressive disorder (including childhood depression), obsessive-compulsive disorder (in both adults and children), bulimia nervosa, panic disorder, and dysphoric disorder.In addition, Fluoxetine is used to treat trichotillomania when CBT results are not satisfactory. In combination with olanzapine, it is marketed under the name Symbyax.
Despite the availability of new drugs, the popularity of Fluoxetine is not declining. In 2010, more than 24.4 million generic prescriptions for Fluoxetine were issued in the United States alone. Fluoxetine is the third most prescribed antidepressant after Sertraline (SSRI; became generic in 2006) and Citalopram (SSRI; became generic in 2003).There were 6 million prescriptions for Fluoxetine in the UK in 2011.

Pharmacological group: Antidepressants
Pharmacological action: Antidepressant, propylamine derivative. The mechanism of action is associated with the selective blockade of the neuronal reuptake of serotonin in the central nervous system. Fluoxetine is a weak antagonist of choline, adrenergic and histamine receptors. Unlike most antidepressants, fluoxetine does not seem to cause a decrease in the functional activity of postsynaptic β-adrenergic receptors.Improves mood, reduces feelings of fear and tension, eliminates dysphoria. Does not cause sedation. When taken in medium therapeutic doses, it practically does not affect the functions of the cardiovascular and other systems.
Systematic (IUPAC) name: (RS) -N-methyl-3-phenyl-3- [4 – (trifluoromethyl) phenoxy] propan-1-amine
Trade names: Prozac, among others
Consumption: oral
Bioavailability: 72 % (peak – after 6-8 hours)
Protein binding: 94.5%
Metabolism: liver
Half-life: 1-3 days (fast), 4-6 days (slow)
Excretion: renal (80%), fecal (15%)
Formula: C ₁₇ H ₁₈ F ₃ NO
Mol. mass: 309.33 g • mol-1
Melting point: 179-182 ° C (354-360 ° F)
Boiling point: 395 ° C (743 ° F)
Solubility in water: 14 mg / ml (20 ° C)

Application

Action

Selective serotonin reuptake inhibitor (SSRI), antidepressant.In terms of chemical structure, it is not similar to classical antidepressants (tricyclic, tetracyclic). Does not show affinity for adrenergic receptors a1, a2 i β, serotonergic, muscarinic, histamine h2, dopaminergic receptors and GABA. After oral administration, it is well absorbed; food intake does not affect the bioavailability of the drug; tmax is 6-8 hours, steady state is achieved after several weeks of use. Binds to plasma proteins by about 95%. In the liver, it is demethylated with the participation of the CYP2D6 isoenzyme, and one of the active metabolites is norfluoxetine.The t1 / 2 of fluoxetine is about 4-6 days and norfluoxetine is about 4-16 days. Determined plasma concentrations are found several weeks after stopping the drug. It is excreted in the form of metabolites – 60% in the urine, 16% in the feces.

Readings

Depressive disorders in adults. Depression of varying severity in children and adolescents over the age of 8 years in cases where psychotherapy does not bring the expected effect. Obsessive-compulsive disorder.Bulimia.

Contraindications

Hypersensitivity to any component of the drug, parallel use of MAO inhibitors. Fluoxetine can be started 14 days after stopping the irreversible MAO inhibitor and at least 24 hours after stopping the reversible MAO inhibitor (eg, moclobemide). MAO inhibitor therapy can be started no earlier than 5 weeks after stopping the use of fluoxetine (if fluoxetine has been used for a long time and / or in large doses, the need to observe a longer interval should be considered).Use with extreme caution in patients with pharmacologically controlled epilepsy, as well as with a history of seizures; should not be used in patients with refractory epilepsy. The drug should be discontinued if seizures develop. Use with caution in patients with a history of mania or hypomania; if the manic phase develops, the drug should be discontinued. In patients with diabetes mellitus, it may be necessary to adjust the dose of antidiabetic drugs.During the course of therapy (especially during the first week), the condition of patients suffering from depression should be carefully monitored for aggravation of symptoms of depression and the appearance of suicidal thoughts and / or suicide attempts. Due to the possibility of developing abnormal skin hemorrhages, it should be used with caution in patients taking SSRIs, especially in the case of concurrent use of oral anticoagulants, drugs that affect platelet function, and in persons with a history of bleeding disorders.During the first weeks of taking the drug, psychomotor agitation may develop (increasing the dose in this case can be harmful). Care must be taken when using electroconvulsive therapy – there is information about the development against its background of prolonged epileptic seizures. There have been cases of hyponatremia, usually in the elderly or in people taking diuretics. Due to the lack of sufficient clinical data, it should be used with caution in patients with concomitant cardiovascular diseases.Abrupt discontinuation of the drug can lead to the development of a withdrawal syndrome; it is recommended to reduce the dose gradually. Preparations containing lactose should not be prescribed to patients with congenital galactose intolerance, primary lactase deficiency or glucose-galactose malabsorption syndrome.

Drug interactions

When considering the need to use a drug that interacts with fluoxetine, one should always take into account the long elimination period of fluoxetine and its pharmacologically active metabolite from the body.Should not be used in combination with MAO-A inhibitors due to the risk of developing serotonin syndrome. During therapy in combination with an MAO-B inhibitor (for example, with selegiline), or serotonergic drugs (for example, with tramadol, triptans), care must be taken due to the possibility of developing serotonin syndrome. Lithium salts and tryptophan can enhance the effect of SSRI drugs. With the parallel use of drugs that affect the central nervous system, it is possible to change the concentration in the blood of drugs such as: carbamazepine, haloperidol, clozapine, diazepam, phenytoin, alprazolam, imipramine, desipramine; care should be taken to consider changing the dosage regimen and to observe the patient for the development of side effects.In the case of simultaneous use or use within 5 weeks after discontinuation of fluoxetine, drugs metabolized by CYP2D6 with a narrow therapeutic index (for example, encainide, flecainide, vinblastine, carbamazepine, tricyclic antidepressants), the minimum effective dose should be used. Preparations containing the herb St. John’s wort can lead to aggravated side effects. There is a possibility of interaction of fluoxetine with drugs that strongly bind to plasma proteins; the concentration of concomitantly used digoxin should be monitored.In patients taking anticoagulants, it is necessary to monitor the coagulation parameters. Therapy in combination with ritonavir, saquinavir, or efavirenz may be associated with an increased risk of developing serotonin syndrome. No drug interactions were found between fluoxetine and chlorothiazide, secobarbital and tolbutamide. There is no information on cases of drug interaction with alcohol, but it is not recommended to use it while taking fluoxetine.
Fluoxetine and norfluoxetine inhibit many isoenzymes of the cytochrome P450 system, which makes drug metabolism possible.Both substances are potent inhibitors of CYP2D6 (the main enzyme responsible for their metabolism) and weak to moderate inhibitors of CYP1A2, CYP2B6, CYP2C9 / 2C19, and CYP3A4. In addition, they inhibit the activity of P-glycoprotein, a type of membrane transport protein that plays an important role in drug transport and metabolism. This widespread effect on the pathway of drug metabolism in the body provides a wide potential for interactions with many commonly used drugs.Concomitant use of Fluoxetine with triptans, Tramadol, or other serotonergic drugs can lead to a rare but potentially life-threatening adverse reaction called serotonin syndrome.
Fluoxetine has been shown to have antimicrobial activity against several groups of microorganisms, mainly against gram-positive microorganisms. The drug also demonstrates synergistic action in combination with certain antibiotics against a number of bacteria.

Side effects

Often: headache, dizziness, anxiety, drowsiness or insomnia, abnormal dreams, asthenia, fatigue, agitation, euphoria, nausea, vomiting, indigestion, diarrhea, dry mouth, taste disturbances, rash, itching, excessive sweating, blurred vision, frequent urination, urinary retention, sexual dysfunction, priapism, galactorrhea. Not very often: difficulty concentrating and thinking, mania, panic attacks, confusion, self-perception disorder, tremor, ataxia, tics, convulsions, psychomotor agitation, yawning, dilated blood vessels, orthostatic hypotension, pharyngitis, shortness of breath, urticaria, alopecia, hypersensitivity reactions, chills, increased sensitivity to light.Rarely: bleeding, hematomas, hyponatremia, abnormal secretion of antidiuretic hormone, symptoms of pulmonary disease (including inflammation with various histopathology and / or fibrosis), hepatic dysfunction, idiosyncratic hepatitis. Very rare: hallucinations, serotonin syndrome, arthralgia, myalgia, toxic epidermal necrolysis. After stopping taking fluoxetine – withdrawal syndrome (weakness, paresthesia, headache, anxiety, nausea). In the first weeks of treatment, the risk of suicide increases.Symptomatic and supportive therapy is recommended; there is no specific antidote.

Sexual dysfunction is a common side effect of SSRIs. In particular, side effects often include difficulty in arousal, erectile dysfunction, lack of interest in sex, and anorgasmia (inability to reach orgasm). Other possible side effects include genital anesthesia, loss or decreased response to sexual stimuli, and ejaculatory anhedonia.Although these sexual side effects are usually reversible, they can last months, years, or a lifetime after stopping the drug completely. This phenomenon is known as “post-SSRI sexual dysfunction.”
According to Eli Lilly, manufacturer of Prozac fluoxetine, the drug is contraindicated in people taking monoamine oxidase inhibitors, Pimozide (Orap) or Thioridazine (Mellaril). The recommendations for the use of the drug indicate that the treatment of patients with hepatic insufficiency “should be approached with caution.”In these patients, fluoxetine and its metabolite norfluoxetine are excreted approximately twice as fast from the body, which leads to a proportional increase in the effect of the drug. The use of ibuprofen in combination with fluoxetine can cause severe intestinal bleeding.
Among the common side effects associated with Fluoxetine and listed in the annotation to the drug, the largest difference with placebo is: nausea (22% versus 9% in the placebo group), insomnia (19% versus 10% in the placebo group), drowsiness (12% versus 5% in the placebo group), anorexia (10% versus 3% in the placebo group), anxiety (12% versus 6% in the placebo group), nervousness (13% versus 8% in the placebo group), asthenia (11% versus 6% in the placebo group) and tremors (9% versus 2% in the placebo group).The side effects most often leading to treatment interruption are anxiety, insomnia and nervousness (1–2% each), and in pediatric trials, mania (2%).
Fluoxetine has sexual side effects in common with other SSRIs, including anorgasmia and decreased libido.
In addition, 7% of patients in clinical trials experienced rash or urticaria, sometimes severe, and a third of these cases experienced discontinuation of treatment. In post-marketing reports, there are several cases of complications that develop in patients with a rash.Symptoms included vasculitis and a lupus-like syndrome. In addition, in some cases, these side effects have been fatal.
Akathisia, that is, internal tension, restlessness and inability to stand still, often accompanied by “constant aimless movement of the feet and legs, and severe anxiety,” is a common side effect of taking Fluoxetine. Akathisia usually begins to appear after starting treatment or increasing the dose and disappears after stopping fluoxetine, reducing the dose, or after treatment with Propranolol.There are reports of a direct link between akathisia and suicidal attempts, with patients feeling better after discontinuing fluoxetine; and with repeated administration of Fluoxetine, they experienced repeated development of severe akathisia. These patients reported that “the development of akathisia provoked suicidal thoughts in them and their previous suicide attempts were associated with this.” The experts note that due to the association of akathisia with suicide and the pain it creates for the patient, “it is vital to raise awareness among staff and patients of the symptoms of the disease.”Less commonly, fluoxetine is associated with movement disorders, acute dystonia, and tardive dyskinesia.
The use of fluoxetine during pregnancy is also associated with an increase in the number of newborns with poor compensatory-adaptive response. Since Fluoxetine is excreted in mother’s milk, the use of the drug during lactation is not recommended. When studying the effect of Fluoxetine on newborn mice, it was shown that early postnatal administration of the drug in adult mice further develops depression and anxious behavior similar to induced depression, for the treatment of which Fluoxetine is used.The American Pediatric Association classifies fluoxetine as a drug with unknown effects on a nursing infant and may be of concern.

Pregnancy and lactation

Caution should be exercised when used during pregnancy, especially in the third trimester and before childbirth due to the serotonergic effect of the drug or the possibility of withdrawal symptoms in newborns (irritability, tremors, hypotension, constant crying, difficulty sucking, poor sleep).Fluoxetine passes into breast milk; consideration should be given to stopping breastfeeding; if breastfeeding continues, the lowest effective dose should be used.

Method of administration and dosage

Inside, regardless of food intake. Adults. Depressive Disorders. 20 mg daily in the morning. Clinical improvement is achieved after 1-4 weeks of taking the drug. If after 3-4 weeks there is no improvement, consideration should be given to increasing the dose to max.60 mg per day. After the symptoms disappear, treatment must be continued for at least 6 months. Obsessive-compulsive disorder. The initial dose is 20 mg per day in the morning; if improvement does not occur after several weeks of therapy, the dose should be increased to max. 60 mg per day. Bulimia. 60 mg per day. Doses> 20 mg per day are administered in 2 divided doses (morning and afternoon). The maximum dose for difficult-to-treat syndromes is 80 mg per day. Episodes of severe depression with moderate or severe course in children and adolescents over the age of 8 years, if psychotherapy does not work.The starting dose is 10 mg per day. After 1-2 weeks, the dose can be increased to 20 mg per day. The dose is selected individually; the minimum effective dose should be used. Treatment must be carried out in conjunction with psychotherapy. In elderly patients, the maximum dose is 60 mg per day. In patients with impaired liver function or taking other drugs that may interact with fluoxetine, the dose should be decreased or the intervals between doses should be increased. The drug should be discontinued gradually (over a period of at least 1-2 weeks.).

Notes

Fluoxetine does not affect intellectual or psychomotor functions, but, like other psychotropic drugs, it can cause impaired concentration both in connection with the disease itself and in connection with taking the drug. For this reason, patients should be informed that the drug adversely affects the ability to drive vehicles and maintain mechanical equipment.

Medical use

Fluoxetine is often used to treat depression, obsessive-compulsive disorder, post-traumatic stress disorder, bulimia nervosa, panic disorder, body dysmorphobia (a mental disorder characterized by the patient’s belief in a physical disability that does not exist in reality, or a sharp overestimation of one) , dysphoric disorder and trichotillomania.Caution should be exercised when taking any SSRI for bipolar disorder, as it may increase the likelihood of mania; however, for bipolar disorder, Fluoxetine can be used in conjunction with antipsychotics (eg, Quetiapine). The drug has also been used to treat cataplexy, obesity and alcohol dependence, as well as binge eating disorder.

Depression

In a six-week, double-blind, controlled trial, Fluoxetine was shown to be effective in treating depression, reducing anxiety and improving sleep.An advantage of fluoxetine over placebo in preventing relapse of depression was demonstrated when patients who initially responded positively to fluoxetine were given it for an additional 38 weeks. Placebo-controlled studies have also demonstrated the effectiveness of Fluoxetine in the treatment of depression in the elderly and in children. However, two meta-analyzes of randomized, placebo-controlled trials suggest that the clinical efficacy of the drug is not very significant in patients with mild to moderate symptoms.Studies show that much of the resistance to SSRIs such as Paroxetine (Paxil) and Citalopram (Celexa) can be attributed to genetic variation in the glycoprotein transporter. Paroxetine and Citalopram, glycoprotein substrates, are actively transported by this protein from the brain. Fluoxetine is not a glycoprotein substrate, and thus, taking Fluoxetine instead of Paroxetine or Citalopram may be beneficial for patients who are resistant to SSRIs.

Obsessive-compulsive disorder

Fluoxetine was shown to be effective in treating OCD in two adults and one 13-week placebo-controlled pediatric study.An improvement in response was observed with higher doses of Fluoxetine, while an inverse relationship was observed with the treatment of depression. In two controlled studies of patients with panic disorder, fluoxetine has been shown to cause a dramatic, 40-50% reduction in the frequency of panic attacks. Fluoxetine has been shown to cause significant reductions in binge eating and bulimia episodes in three double-blind studies. With long-term treatment for one year in patients who demonstrated an initial response to fluoxetine, it has been shown that the drug has an advantage over placebo in the prevention of bulimic episodes.

Antiviral agent

In 2012, researchers at the University of California, Los Angeles discovered that Fluoxetine and various other SSRIs could act as antiviral drugs in therapy against enteroviruses such as polio. This discovery was called by the American Society of Microbiology “a major breakthrough”, since there are currently no drugs used against enteroviruses.

Withdrawal Syndrome

Several cases of severe withdrawal symptoms after sudden discontinuation of Fluoxetine have been reported in the literature.However, various studies have shown that side effects when discontinuing Fluoxetine are rare and usually quite mild, especially when compared with Paroxetine, Venlafaxine and Fluvoxamine, which is likely due to the relatively long pharmacological half-life of Fluoxetine. One of the recommended strategies for controlling the withdrawal syndrome of other SSRIs, in cases where dose reduction of the original SSRI is ineffective, is to replace the original drug with Fluoxetine.The effectiveness of this strategy is supported by data from double-blind controlled trials. Several studies have not demonstrated that the drug causes any increase in side effects when treatment with Fluoxetine was interrupted for a short time (4-8 days) and then resumed, and this result is not consistent with the slow elimination of the drug from organism.
With interruption of treatment with Sertraline (Zoloft), more side effects were observed, and with interruption of treatment with Paroxetine, significantly more.In a longer 6-week blind discontinuation study, there was a slight increase (32% versus 27%) in the overall incidence of new or worsening existing side effects in the group who discontinued Fluoxetine compared to the group whose members continued treatment. However, patients who discontinued treatment had a significant increase (4.2%) in sleepiness at 2 weeks and an increase in dizziness of 5-7% at 4-6 weeks. This long period of withdrawal symptoms and dizziness persisting until the very end of the study is also consistent with the long half-life of Fluoxetine in the body.According to a 2007 summary report of available data, fluoxetine had the lowest withdrawal rate of any antidepressant drug studied, including Paroxetine and Venlafaxine.

Suicide

The FDA has now mandated all antidepressant manufacturers to place a black box warning on their products that antidepressants may increase the risk of suicide in people under the age of 25. This warning is based on statistical analyzes carried out by two independent FDA expert groups that have shown a 2-fold increase in the number of suicidal thoughts and related behaviors in children and adolescents, as well as a 1.5-fold increase in suicidal tendencies in individuals with aged 18-24.These rates were slightly lower in the over 24 group, and much lower in the 65 and over group. Donald Klein criticized this analysis, noting that suicidal tendencies, that is, suicidal thoughts and behavior, do not necessarily lead to committing suicide, and that the possibility cannot be denied that antidepressants can prevent the possibility of actual suicide despite an increase in suicidal thoughts.
There is relatively little data on fluoxetine compared to antidepressants in general.The FDA pooled 295 trials of 11 antidepressants to carry out the above analysis of antidepressants. When considered separately, the use of fluoxetine in children caused a 50% increase in the risk of suicide, while in adults this risk was reduced by about 30%. In addition, an analysis by the United Kingdom’s Medicines and Healthcare Products Administration (MHRA) showed a 50% increase in the number of suicidal thoughts and behaviors in children and adolescents with fluoxetine compared to placebo.According to the MHRA, in adults, fluoxetine does not change the number of self-harm and statistically significantly reduces the number of suicidal thoughts by 50%.

Violence

Psychiatrist David Healy and several active patient groups have reported cases of violent acts committed by individuals taking Fluoxetine or other SSRIs. Taking these drugs can encourage susceptible individuals to commit violent acts, the report says.
Serial reviews of this type have been criticized because the effects of the disease are often mistaken for the effects of treatment.Other studies, including randomized clinical trials and observational studies, have shown that fluoxetine and other SSRIs can reduce violence. A randomized clinical trial by the American National Institute of Mental Health found that fluoxetine caused a decrease in domestic violence in alcoholics with a history of such behavior. A second clinical trial at the University of Chicago showed that fluoxetine caused a decrease in aggressive behavior in patients with intermittent aggressive disorder.In a clinical trial, fluoxetine was found to reduce aggressive behavior in patients with borderline personality disorder. These results are indirectly supported by research showing that taking other SSRIs can reduce the risk of violence and violent behavior. The NBER study, which examined international trends in antidepressant benefits and crime rates in the 1990s, found that an increase in antidepressant prescriptions was associated with a decrease in violent crime.

Pharmacokinetics

Fluoxetine has a relatively high bioavailability (72%), and peak plasma concentrations after administration are reached within 6 to 8 hours. It binds well to plasma proteins, mainly albumin.
Fluoxetine is metabolized in the liver by isoenzymes of the cytochrome P450 system, including CYP2D6. The role of CYP2D6 in the metabolism of fluoxetine may be clinically important, as there is great genetic variation in the functioning of this enzyme among humans.Only one metabolite of fluoxetine, norfluoxetine (N-demethylated fluoxetine), is biologically active.
Fluoxetine and its active metabolite, norfluoxetine, are distinguished from other antidepressants by their extremely slow elimination from the body. Over time, fluoxetine and norfluoxetine inhibit their own metabolism, so that the half-life of fluoxetine instead of 1 day begins to be up to 3 days after a single dose, and from 4 to 6 days after long-term use. In addition, after prolonged use, the half-life of norfluoxetine increases (16 days).Thus, during the first few weeks of treatment, the concentration of the drug and its active metabolite in the blood continues to increase. A constant blood concentration is achieved after four weeks of use. In addition, the concentration of fluoxetine and its metabolites in the brain continues to rise for at least the first five weeks of treatment. This means that after applying the current dose, the drug will take effect in at least a month. For example, in one 6-week study, the median time to consistent response was 29 days.In addition, it can take several weeks for the drug to be completely eliminated from the body. During the first week after stopping treatment, the concentration of fluoxetine in the brain decreases by only 50%, the level of norfluoxetine in the blood 4 weeks after stopping treatment is about 80% of the level at the end of the first week of treatment, and 7 weeks after stopping taking norfluoxetine is still can be found in the blood.
The PET study compared the effects of a single dose of Fluoxetine on exclusively heterosexual and exclusively homosexual men who claimed that their past and present sexual behavior, desires and fantasies were directed exclusively to women or men, respectively.The study found that in some areas of the brain, the metabolic response of these two groups proceeded differently. “Both groups, however, show similar broadly lateralized metabolic responses to fluoxetine (versus placebo), with most brain regions in these groups responding in the same way.” These groups “did not differ in behavioral characteristics or blood levels of fluoxetine.”
Fluoxetine is a selective serotonin reuptake inhibitor and inhibits the reuptake of norepinephrine and dopamine to some extent.However, Eli Lilly’s researchers found that a single high dose of Fluoxetine in rats also saw a significant increase in the concentration of norepinephrine and dopamine in the brain. This effect may be mediated by 5HT2a receptors and, in particular, 5HT2, which are inhibited by higher concentrations of Fluoxetine. Scientists at Eli Lilly have also suggested that exposure to dopamine and norepinephrine receptors may enhance the antidepressant effects of fluoxetine.According to other researchers, the strength of this effect, however, remains unclear. There was no increase in dopamine and norepinephrine levels with fluoxetine at lower, more clinically relevant doses. In addition, in electrophysiological studies it was shown that only when taking large doses of Fluoxetine were changes in the activity of norepinephrinergic neurons in rats. Some authors, however, argue that these data may still be of clinical importance for the treatment of severe illnesses when taking fluoxetine in doses exceeding therapeutic doses (60-80 mg).Compared to other SSRIs, “Fluoxetine is the least selective,” and exhibits a 10-fold difference in binding capacity between the first and second neural targets (eg, with the pumps of serotonin and norepinephrine, respectively). All values ​​greater than a 10-fold difference result in negligible activation of secondary neural targets.
In addition to its known effects on serotonin, fluoxetine also increases the density of endogenous opioid receptors in the rat brain. It is unclear if the same occurs in humans, but if so, it may explain some of the antidepressant or side effects of Fluoxetine.

Measurements in body fluids

For monitoring during treatment, confirming the diagnosis of poisoning in hospitalized patients, or assisting in a forensic examination, the amount of fluoxetine and norfluoxetine can be quantified in blood, plasma, or serum. Fluoxetine concentrations in blood or plasma are typically 50-500 mcg / L in antidepressant users, 900-3000 mcg / L in acute overdose survivors, and 1000-7000 mcg / L in fatal overdose victims.Concentrations of norfluoxetine are approximately equal to those of the parent drug during long-term therapy, but can be significantly lower in acute overdose, since it takes at least 1-2 weeks to reach equilibrium of the metabolite.

Mechanism of Action

Fluoxetine acts primarily as a serotonin reuptake inhibitor. Fluoxetine inhibits the reuptake of serotonin, with the result that serotonin, when released, is inhibited for a longer period.Some of the effects of fluoxetine also depend on its weak 5-HT2C receptor antagonism. In addition, fluoxetine acts as a sigma-1 receptor agonist, stronger than citalopram but weaker than fluvoxamine. However, the meaning of this property is not entirely clear.

History

In 1970, Eli Lilly and Company began work that eventually led to the discovery of Fluoxetine, through a collaboration between Brian Molloy and Robert Rathbun. At the time, the antihistamine diphenhydramine was known to have some antidepressant properties.The compound 3-phenoxy-3-phenylpropylamine, structurally similar to diphenhydramine, was taken as a basis. Molloy synthesized dozens of derivatives of this compound. Testing the physiological effects of these compounds in mice led to the discovery of nisoxetine, a selective norepinephrine reuptake inhibitor currently widely used in biochemical experiments.
Later, in the hope of finding a derivative that only inhibits serotonin reuptake, another Eli Lilly scientist, David T. Wong, suggested retesting the compounds in vitro for the reuptake of serotonin, norepinephrine, and dopamine.This test by Jong-Sir Horng in May 1972 showed that the compound, later named Fluoxetine, was the most potent and selective serotonin reuptake inhibitor of all compounds tested. In 1974, Wong published the first article on Fluoxetine. A year later, the compound was given the official chemical name “Fluoxetine”, and Eli Lilly and Company launched it under the trade name “Prozac”. In February 1977, Dista Products Company, a division of Eli Lilly and Co, submitted a new request to the US FDA for Fluoxetine.In May 1984, the German Regulatory Agency (BGA) rejected Prozac as “completely unsuitable for the treatment of depression.” In May 1985, then-FDA chief safety investigator, Dr. Richard Karit, wrote: “Unlike the profile of a traditional tricyclic antidepressant, the side effects of Fluoxetine are closer to stimulants than sedatives.” According to him, “the specific profile of adverse side effects of Fluoxetine may in the future lead to large clinical impediments to the use of this drug for the treatment of depression.”Fluoxetine appeared on the Belgian market in 1986. More than ten years later, in December 1987, the FDA finally approved Fluoxetine, and a month later, Eli Lilly began selling Prozac, whose annual sales in the United States reached $ 350 million during the year.
Controversy ensued soon after the Lilly researchers published a document titled “Prozac (Fluoxetine, Lilly 110140), the first selective serotonin reuptake inhibitor and antidepressant,” which claimed that fluoxetine was the first selective serotonin reuptake inhibitor (SSRI).Two years later, the authors were forced to publish an amendment, recognizing that the first SSRI called Zimelidine was developed by Arvid Karlsson and colleagues.
Eli Lilly’s US patent for Prozac (Fluoxetine) expired in August 2001, prompting an influx of generic drugs into the market. In an attempt to stem the decline in sales of Fluoxetine by Eli Lilly after the patent expired, Prozac was renamed Sarafem for the treatment of PMS.
A meta-analysis published in February 2008 collected data from 35 clinical trials of four new antidepressants (Fluoxetine, Paroxetine (Paxil), Nefazodone (Serzone), and Venlafaxine (Effexor)).These antidepressants, belonging to three different pharmacological groups, were considered collectively, that is, the authors did not analyze them separately. The authors concluded that “although the difference [between placebos and antidepressants] readily achieves statistical significance,” it does not meet the criteria of clinical significance used by the UK’s National Institute for Health and Clinical Standards, “in all but the most depressed patients.” …Articles titled “Making the Prozac Myth” and “Prozac Doesn’t Help Most Depressive Patients” began to appear in the press, in which the authors concluded from general conclusions about the relative effectiveness of antidepressants and placebo that fluoxetine was ineffective. In the next article, the authors of the meta-analysis noted that “unfortunately, the media often portray the results of our work in the form of headlines such as” antidepressants do not work “and the like, which fundamentally distorts the more subtle structural conclusions of our report.”As of April 2, 2010, Fluoxetine is one of four antidepressants that the FAA (Federal Aviation Administration) allows pilots to carry on board. Three others include Sertraline (Zoloft), Citalopram (Celexa), and Escitalopram (Lexapro).

Other trademarks

• Zactin (Australia)

• Lovan (Australia)

• Fluohexal (Australia)

• Auscap (Australia)

• Depreks (Turkey)

• Floxet (Hungary; Egis Pharmaceuticals Ltd.)

• Flunil (India) Intas Biopharmaceuticals

• Prodep (India)

• Fludac (India)

• Flutine (Israel)

• Fluox (New Zealand)

• Fluoxetina (Colombia, Brazil)

• Fluzac (Ireland)

• Fluxen – Fluxen (Ukraine)

• Fluoxin (Romania)

• Fontex (Denmark, Norway, Sweden)

• Foxetin, Eburnate, Alental, Neupax, Sora, Lapsus (Argentina)

• Ladose (Greece)

• Flusetin (Bosnia and Herzegovina)

• Philozac (Egypt)

• Biozac, Deprexetin, Fluval, Biflox, Deprexit, Sofluxen, Floxet, Ranflutin – (Bulgaria)

• Flunisan, Orthon, Refloksetin, Fluoxetine – (Macedonia)

• Motivest (Philippines)

• Seronil (Finland)

• Lorien (South Africa)

• Affectine (Israel)

• Proxetin (Thailand)

• Stream (Pakistan)

• Fluxil (Singapore)

Prozac in Popular Culture

The mention of the drug Prozac is found in many books, films and songs of popular culture.Among them:
• The book “Listening to Prozac”, written in 1993 by psychiatrist Peter D. Kramer.
• Memoir “The Nation of Prozac”, written in 1994 by Elizabeth Werzel, as well as the film of the same name in 2001, starring Christina Ricci as Werzel.
• The 1995 Blur song “Country House” contains the following lines: “He’s reading Balzac and knocking back Prozac / It’s the helping hand that makes you feel wonderfully bland.” / It is like a helping hand bringing amazing calmness “).• A well-known drug criticism book, Commentary on Prozac, written by psychiatrist Peter Breggin and published in 1994 (ISBN 0312114869).
• Prozac is referenced in the Superman graphic novel The Red Son, where the Botanist uses him to manipulate the mood of the people in Superman’s empire.
• In Alison Bechdel’s Dykes to Watch Out For comic series, Lois takes Prozac in the 1997 book Hot, Trrobbibg Dykes to Watch Out For.
• “Diary of Prozac” 1998, a confessional memoir by Lauren Slater.• “Plato, not Prozac!” is the title of a 1999 book from the self-help series by Lou Marinoff, which suggests using classical philosophy as an alternative to the conventional pro-pharmaceutical approach to psychotherapy.
• The song “1985” by the group “The Bowling For Soup” describes the nervous breakdown / crisis of a middle-aged housewife from the suburbs. It begins with the lines “Debbie just hit the wall / she never had it all / One Prozac a day / husband’s a CPA …” senior accountant … “)
• “Pets on Prozac” is the name of the UK underground house band formed in 2010.• Prosac is one of Tomcraft’s most notable progressive house works. The main text of the song is read from the pharmacological description and indications for the use of the drug.
• Bernard Sumner (musician from New Order and Joy Division) chronicled his experiences with Prozac and his influence on his work for the BBC documentary The Prozac Diaries.
• Prozac is often mentioned in the popular comedy series “Ellie McBeal”, where in season 3 the eponymous character (played by Calista Flockheart) adopts Prozac at the conviction of his psychiatrist Dr. Shirley Flott (played by Betty White).Flott describes the miraculous benefits of Prozac on an almost Eucharistic scale, telling Ellie that she “won’t find happiness in love or God, happiness is in pills.” Flott also claims that she herself takes Prozac in suppository form. Although Ellie initially starts taking Prozac to combat her hallucinations, she is later discouraged by a friend and colleague, and Ellie ends up flushing the pills down the toilet.
• In the HBO series The Sopranos, gangster Tony Soprano (James Gandolfini) has a tendency to panic attacks.His psychiatrist Dr. Jennifer Melfi (Lorraine Bracco) prescribes Prozac for him.
• Prozac takes place in the movie Love and Other Drugs, starring Jake Gyllenhaal as a Pfizer drug dealer trying to promote Zoloft. He discards most of the Prozac party, which is subsequently picked up by vagrants and the drug, thus spreading throughout the country.
• “ProzaKc Blues” is a song by progressive rock band King Crimson from their 2000 album ConstruKction of Light.• “Prozac +” is the name of an Italian punk band.

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Fluoxetine is a fairly common drug on the domestic market used to treat various depressive conditions, which are accompanied by a feeling of fear and anxiety.