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Prozac (fluoxetine) is an SSRI antidepressant most commonly used in a number of psychiatric disorders.

Prozac is one of the oldest SSRI medications and has seen very widespread use since its introduction in the 1980s. It has a well-established record of effectiveness and, if used as directed, safety. Treatment is typically long term, often spanning years.

Conditions Prozac is commonly used to treat include:

• Depression
• Anxiety
• Post-traumatic stress disorder
• Bulimia nervosa
• Binge eating
• Obsessive compulsive disorder
• Premenstrual dysphoric disorder

Prozac is distinguished among SSRI medications for having a stimulating effect rather than a sedative effect (though some individuals do find Prozac induces drowsiness instead), making it the ideal choice for patients experiencing low energy or who find other SSRIs cause drowsiness. Patients who tend to be high-energy, prone to agitation, or who have difficulty sleeping might want to consider other options.

Getting Started with Prozac

Treatment is similar in all applications, though dosage adjustments may need to be made for age, weight, other medications being taken, and other medical conditions that may be present. In otherwise healthy adults treatment is usually as follows:

• Start with 20 mg per day for at least four weeks.
• If no improvements are seen, dosage may be increased in 20 mg increments every four weeks, up to 80 mg per day.
• The majority of patients find 40 to 60 mg per day to be effective.
• Do not exceed 80 mg per day without explicit doctor instruction.
• Treatment may continue for as long as it provides benefit.
• Treatment should not end abruptly; dosage should be gradually tapered down over several weeks to prevent disruptive withdrawal symptoms. A doctor can help develop a discontinuation plan.

The medication is usually administered via tablets. In smaller doses, 20 mg or less, tablets are taken once per day in the morning. At higher doses, the daily dose is usually divided into two smaller doses, taken morning and afternoon. Use at bedtime is generally inadvisable as it can cause sleeping problems, though a few patients find Prozac has a sedating effect and prefer taking it at bedtime. Patients taking Prozac shortly before bed may experience unusually vivid dreams.

Warnings & Adverse Reactions

Most people who take Prozac experience only mild side effects, and these often stop occurring in the first few weeks of treatment. Most commonly reported are:

• Insomnia
• Drowsiness
• Dry mouth
• Stomach upset
• Mild tremor
• Lightheadedness
• Sweating

Patients with a history of liver or kidney issues, diabetes, seizures, or glaucoma are at greater risk of experiencing more serious side effects. Discuss potential risks and warning signs with a doctor before taking Prozac.

Unfortunately some sexual side effects are relatively common with SSRI use, including loss of libido, vaginal dryness, erectile dysfunction, and delayed ejaculation. There are many products that can alleviate most of these symptoms---such as Viagra or Cialis---but there are no widely-recognized treatments for lost libido. Fortunately sexual side effects nearly always reverse when SSRI treatment stops.

Prozac can interact with a wide range of other medications, including other antidepressants, blood thinners, widely-used over-the-counter products like NSAIDs or cold medications, triptan medications used for migraines, and many others. Always check with a doctor or pharmacist before mixing medications.

There is a risk of harm to unborn babies if Prozac is taken while pregnant, particularly in the third trimester.