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Prozac (Fluoxetine)

The usual dose for Prozac is 20mg once per day, to treat depression.

What is Prozac?

Prozac is the commercial name for Fluoxetine hydrochloride. It is one of the most prescribed drugs in the world. It has been prescribed to more than seventeen million Americans. It is an important antidepressant in the SSRI (selective serotonin uptake inhibitor) class. It blocks the reuptake of serotonin at the nerve endings; thereby allowing it to accumulate to higher levels. It has been used in treating all kinds of depression from milder ones to major ones. "Prozac has indeed helped many people who suffered from severe depression" reports Dr. Gary Null in his article Dangers of Prozac: Part -I. Dista products market Fluoxetine, which is a division of Eli Lilly and company.

When was Prozac discovered?

Prozac was originally developed in 1972 by Bryan B. Molley, David T. Wong, Ray W. Foller, and other research scientists employed by Eli Lilly and Company (Fieve, 1994, p. 11). "Fluoxetine (Prozac) first appeared in scientific literature as Lilly 110140 (the hydrochloride form) in August 15th 1974 in the issue of Life Sciences" (Wong, Bymaster, & Engleman, 1995, p. 411). After that many studies had been performed on the drug and its effect as an antidepressant. Finally on December 29th 1987 it was approved by the FDA as an antidepressant medication. (Wong, Bymaster, & Engleman, 1995, p. 412). It was introduced in the market at the beginning of the year 1988.

What is Depression?

Depression is believed by some psychiatrists to be caused by an imbalance of a natural chemical in the body called serotonin (Romano, p.1)

How does Prozac work?

Prozac increases the levels of serotonin the brain. Serotonin, which is a non-localized neurotransmitter, regulates our general feelings of security and well being in some way. This chemical is active when it is present in the synapses between the nerve cells (Kile, 1993, p.1). "Prozac works by slowing the brain's reuptake of serotonin, thus making it more available to the receiving cell and prolonging the chemical's effect on the brain" (Kile, 1993, p.2).

The reason serotonin being so important neurotransmitter is that its level controls our moods and psychological health to a great extent. It is responsible for a whole host of positive feelings; some of them include sense of well being, personal security, confidence, and higher levels of self-esteem (Robertson & Monte, 1997, p. 35). Some of the behaviors that occur when serotonin levels are low are as follows: Declines in moods, depression, low energy and fatigue, low self-esteem, poor concentration, confusion, difficulty making decisions, fluctuations in appetite, decreased sex drive, excessive feelings of guilt and unworthiness (Robertson & Monte, 1997, p. 37).

Who is this drug for?

The FDA has originally approved this drug for patients suffering from major depression or dysthymia, which is a milder form of depression. (Fieve, 1994, p.146). However in the year 1994 FDA also approved Fluoxetine for treatment of OCD and Bulimia (Wong, Bymaster, & Engleman, 1995, p. 412).

Who is this drug not for?

This drug is not advisable for people who have known hypersensitivity. It should also be avoided in the case of people who are underweight. Prozac sometimes causes weight loss. Sometimes it activates mania in some bipolar patients. It should not be prescribed to patients who have history of seizures. It has been observed that Prozac can lower the seizure threshold. It should be discontinued if some conditions such as fever, rash or breathing problems should occur.

What is the recommended dosage?

Usually Prozac is started anywhere from 10 to 20 mg per day. If the patient does not respond after two to four weeks it can be increased to 40-80 mg a day. For children and elderly a low dosage of 10 mg is recommended. (Fieve, 1994, p.47)

What are some of its side effects?

There have been a variety of side effects of Prozac. There are both major and minor side effects of this drug. It usually depends on the individual how he or she reacts to this drug. Some of the side effects that have been reported so far are nausea, insomnia and nervousness, headaches, anxiety, agitation, tremors, diarrhea, mouth dryness, anorexia, and excessive sweating (Jonas, & Schaumburg, 1991, p. 61). Some of the major side effects include akathisia, permanent neurological damage, psychosis and suicidal obsessions. Some sources have even said that "it not only produces troubling side effects, it can also be harmful and even deadly when combined with certain other drugs"(Null, & Feldman, p.1).

"Akarthisia is a need to move about. The person feels anxious or irritable and is compelled to stand up, pace, shuffle his or her feet" (Null, & Feldman, p.1). Eli Lilly and Company also states this as one of the side effect in their information sheet. Akarthisia is linked with a breakdown in the ability to control impulses. Therefore, it has been associated with violent and suicidal acts in number of studies and reports (Null, & Feldman, p.1).

It has been reported that Prozac can also cause psychosis. Psychosis is the condition when "a person's nervousness may reach a psychotic level when the over stimulation of the nervous system is severe. People can become paranoid, extremely depressed, suicidal and dangerous to others around them" (Null, & Feldman, p.1). "Beyond the connection between akathisia and acts of violence, some patients of Fluoxetine have had behaviors such suicidal thoughts and obsessions.
What are some other uses of Prozac?

It has been found effective in treating obsessive compulsive behavior. It has also suitable for patients suffering from panic disorder and other types of anxiety disorders and phobias. "Doctors and psychologists began seeing that large numbers of patients suffering form depression, obsessive compulsive disorder, and eating disorders respond miraculously to the drug" (Kile, 1993, p. 1). One of the patient after taking the drug stated "I had never felt this better in my life." Not only were some patients free from depression, they reported increased mental and verbal activity, greater assertiveness greatly improved self-esteem, self-confidence and social poise (Kile, 1993, 1).

Some other disorders Prozac is useful for as stated in the book Everything you need to know about Prozac are as follows: eating disorders, anorexia, bulimia, obesity, body dysmorphic disorder, and alcoholism.

What are some other alternatives to Prozac?

There has been enormous research going on antidepressants. One of the alternatives to Prozac is St John's Wort. It offers a gentler, less toxic solution for depression and anxiety ("Prozac Alternatives", p. 1). It contains hypercin, which inhibits the enzyme monoamine Oxidase (MAO) which is responsible for breakdown of two brain neurotransmitters serotonin and norepinephrine. Some of the other factors that can help increase serotonin levels in the brain naturally as stated in the book Natural Prozac are as follows: Carbohydrate rich diet increases the blood levels of tryptophan, an amino acid that acts as a precursor to serotonin. When carbohydrate is consumed, blood fills up with tryptophan, which in turn produces lots of serotonin. Moreover, exercise helps increase serotonin levels. All relaxing types of exercise are declared useful. Sometimes reading inspirational literature, prayer and meditation might also be beneficial. Furthermore, gentle music such as soft jazz and other nature music should be included in patient's schedule. Finally, service to others might also be helpful as it gives a sense of security and linkage to others (Robertson, & Monte, 1997, p.41).
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