Fluoxetine: Proficient Antidepressant

Depression is a disease state that affects not only a person’s mental health, but also their behavior.  It affects a person’s life by increasing thoughts of hopelessness and sadness.  Depression is known as a condition of persistent sadness and loss of interest in routine activities, even those activities that you used to enjoy doing.  Depression is examined to be the leading cause of disability.  It is an ongoing problem and takes time (several weeks, months, even years) to treat.

Signs and symptoms of depression:

The signs and symptoms of depression are different for everyone. Here some common symptoms of depression are given below:

  • Poor concentration
  • Feeling of worthlessness
  • Thoughts of hurting yourself
  • Loss of interest
  • Persistent sadness
  • Feeling of emptiness, hopelessness
  • Irritability, frustration over even small things.
  • Sleep disorders
  • Decreased energy, Fatigue
  • Anxiety
  • Changes in appetite

Causes of depression:

Depression as a complex disorder has no exact causes yet to be known. Some main causes of depression that can be:

  • Conflict
  • Age
  • Abuse
  • Use of certain medications
  • Genes
  • Gender
  • Death or loss
  • Serious illness
  • Big events can even be good events too like a new job, graduation, marriage, etc.
  • Substance misuse
  • Personal issues

Antidepressants are considered essential drugs for the treatment of depression.  They are used to treat many conditions related to depression, such as major depressive disorder, chronic panic attacks, OCD (obsessive compulsive disorder).

 In this class of antidepressants, one of them SSRIs(Selective Serotonin Reuptake Inhibitors) and Fluoxetine is an SSRI.  Fluoxetine is used to treat many conditions such as depression, bulimia nervosa(eating disorder),OCD, panic disorder, and postmenopausal dysphoric syndrome. It works by inhibiting the reuptake of serotonin by neurons thus helps people with panic, depression, anxiety, OCD etc.

Fluoxetine Brand Names:

  • Prozac
  • Rapiflux
  • Sarafem
  • Selfemra

Fluoxetine Uses:

It is used to treat:

  • Depression 
  • Bulimia Nervosa(an eating disorder)
  • Panic Disorder 
  • Obsessive Compulsive Disorder(OCD)
  • Combination therapy of Fluoxetine and Olanzapine is used to treat Depression associated with Bipolar 1 Disorder.
  • Premenstrual Dysphoric Disorder(PMDD)

Sertraline: Proficient Antidepressant 

Sertraline is also an antidepressant that belongs to SSRIs. Zoloft is used to treat different mental health issues. Zoloft increases the level of Serotonin in the brain so improves the symptoms of depression and anxiety. It also improves your mood, energy level.

Fluoxetine Dosage:

Fluctuations Dosage varies for different conditions. 

  • Fluoxetine Dosage for Bulimia Nervosa:

Typical Dosage 

60 mg orally once per day in the morning.

Some patients will need to start at a low dose and titrate to the recommended dose over several days.

For treatment of Bulimia Nervosa doses

greater than 60 mg have not been studied systematically.

  • Fluoxetine Dosage For OCD:

Typical dose;

  Initial dose: 

20 mg orally once a day in the morning, This dose is increased after several weeks if adequate clinical improvement is not observed.

   Maintenance dose: 20 to 60 mg taken orally each day

  Maximum dose: 80 mg taken orally each day

If a patient’s required dose is greater than 20, then dose should be given in divided doses i.e. in the morning and at noon.

  • Fluoxetine Dosage  for Panic Disorder:

Typical dose;

Initial dose:

10 mg orally once a day 

This dose is increased after one week by 20 mg orally once a day.

      Maintenance Dose: 20 to 60 mg taken orally each day

     Maximum Dose: 60 mg taken orally each day.

If a patient’s required dose is greater than 20, then dose should be given in divided doses i.e. in the morning and at noon.

For treatment of Panic Disorder dose greater than 60 mg have not been studied systematically.

  • Fluoxetine Dosage for Depression:

Typical Dosage;

  Initial dose:

 20 mg orally once daily

This dose may be increased after several weeks if required clinical improvement is not observed.

   Maintenance dose: 20-60 mg taken orally each day

   Maximum dose: 80 mg taken orally each day

Dose for Delayed release oral capsules:

  Initial dose: 

  90 mg taken orally once a week

Capsules dose should be taken 

7days after the last daily dose of Initial therapy (20 mg).

If a patient’s required dose is greater than 20, then dose should be given in divided doses i.e. in the morning and at noon. If a satisfactory response is not obtained with once-weekly oral fluoxetine, consideration should be given to reverting to a daily dose of fluoxetine using Initial dose therapy.

  • Fluoxetine Dosage for Premenstrual Dysphoric Disorder:

   Initial dose:

 Continuous regimen: 20 mg orally once daily on every day of the menstrual cycle

   Cyclic regimen: 20 mg orally once a day beginning 14 days before the expected onset of menstruation until the first full day of menstruation, and repeated for each new cycle.

   Maintenance dose: 20 to 60 mg taken orally each day for continuous or intermittent regimen

   Maximum dose: 80 mg taken orally each day

A daily dose of -60 mg has not been shown to be significantly more effective than 20 mg per day while a daily dose of 20 mg has been shown to be effective for treatment for up to 6 months.

Fluoxetine Interactions:

Different drugs can interact with Fluoxetine and it may affect the efficacy of Prozac or it may result in some serious adverse effects. So the patient should tell you about all his medicines that he is taking currently. This is not a complete list of drugs which interact with Prozac there are many other drugs too.

Drug-Drug Interactions:

  • Adderall(Amphetamine)
  • Vyvanse(lisdexamfetamine)
  • Metoprolol Tartrate(Metoprolol)
  • Metoprolol Succinate ER(Metoprolol)
  • Lyrica(Pregabalin)
  • ProAir HFA(albuterol)
  • Synthroid(Levothyroxine)
  • Xanax(Alprazolam)
  • Zyrtec(Cetirizine)

Patients should avoid the use of alcohol while taking Sarafem because it can increase the nervous system side.

Disease-Drug Interactions:

  • Depression 
  • Weight loss
  • Renal Dysfunction
  • Mania
  • Platelet Functions
  • QT Prolongation 
  • Seizures Disorder 
  • Liver diseases
  • SIADH(Syndrome of Inappropriate secretion of antiDiuretic Hormone)
  • Hyponatremia
  • Glaucoma 
  • Diabetes

Fluoxetine Side Effects:

  • Insomnia
  • Headache 
  • Drowsiness 
  • Nausea
  • Anxiety 
  • Diarrhea 
  • Flu like symptoms 
  • Nervousness 
  • Weakness
  • Tremor 
  • Throat pain
  • Yawning
  • Anorexia
  • Decreased sex drive
  • Abnormal dreams 
  • Allergic Rash

Fluoxetine Warnings:

  • Serotonin Syndrome:

By extremely increased levels of Serotonin, it causes Serotonin Syndrome which is life threatening.

  • Suicidal thoughts:

This medicine raises the risk of Suicidal thoughts or behavior. So if a patient experiences unusual behavior he should tell his/her doctor. 

  • Higher bleeding risk:

If a patient is taking NSAIDS WITH Sarafem, it increases the high bleeding risk.

  • Abnormal heart rhythm:

Fluoxetine affects your heart and can cause abnormal heart rate, so if you feel this, consult your doctor.

  • Mania:

If any patient of bipolar syndrome is treated with only one antidepressant, it can cause Manic episodes to that patient.

  • Withdrawal:

If the patient suddenly leaves the use of citalopram it causes withdrawal symptoms of depression.

Fluoxetine Pros and Cons:

Pros:

  • It is good for people who have low energy because it is more energising than other SSRIs.
  • It can cause weight loss which is beneficial for people who are overweight.
  • It is a good antidepressant as it can be used in treatment of many conditions related to depression.

Cons:

  • It can increase the risk of Suicidal thoughts in young.
  • It takes several weeks to show its effectiveness.
  • It can interact with many other medications.

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