Fluoxetine, Prozac® Weekly, Rapiflux®, Sarafem®, Selfemra®
Fluoxetine (Prozac) is used to treat depression, obsessive-compulsive disorder (bothersome thoughts that won’t go away and the need to perform certain actions over and over), some eating disorders, and panic attacks (sudden, unexpected attacks of extreme fear and worry about these attacks). Fluoxetine (Sarafem) is used to relieve the symptoms of premenstrual dysphoric disorder, including mood swings, irritability, bloating, and breast tenderness. Fluoxetine is in a class of medications called selective serotonin reuptake inhibitors (SSRIs). It works by increasing the amount of serotonin, a natural substance in the brain that helps maintain mental balance.
Chemically and Mechanistically Related Drugs
Beginning in the 1950s, scientists developed a number of synthetic drugs for the treatment of depression, which represented a major step forward at the time.
The tricyclic drugs (Tofranil, (Elavil, Limbitrol, Endep, Norpramin, Adapin, Sinequan, Pamelor, Aventyl ) were the first antidepressant medications. They dominated the market for more than twenty years, and are still used today, though less frequently. They work by desensitizing a receptor in the neuron that absorbs the neurotransmitters norepinephrine and dopamine into the cells. This results in higher levels of these two chemicals in the synapse, and consequent improvements in mood.
A serious problem with the tricyclics is their level of side effects, particularly in patients over age sixty-five.
The Monoamine Oxidase Inhibitors
The monoamine oxidase inhibitors (Nardil, Parnate), or MAOIs, have a different mechanism of action than the other antidepressants. They work by reducing the quantity of the enzyme MAO within the synapse.
While the MAOIs have fewer side effects than the tricyclic drugs, they can still cause problems in some individuals.
The Selective Serotonin Re-Uptake Inhibitors
Prozac (fluoxetine hydrochloride) was the first selective serotonin re-uptake inhibitor, or SSRI, put on the market. Prozac’s success has spawned other SSRIs, including Zoloft (sertraline hydrochloride) and Paxil (paroxetine hydrochloride).
Prozac and the other SSRIs can exact a high price for their benefits. Prozac is considered better than the older drugs because “only” 17 percent of the people who try it have to stop because of negative experiences, compared with nearly a third (31 percent) of the patients taking the tricyclic drugs. Zoloft and Paxil are similar to Prozac in terms of their side effects.
Wellbutrin (bupropion hydrochloride) seems to boost norepinephrine function, with no impact on serotonin levels. The main difficulty with this drug is its association with seizures.
Desyrel (trazodone hydrochloride) works on the serotonin system. Rather than being used for its antidepressant effects, it is most often prescribed along with Prozac because the drowsiness Desyrel induces counteracts Prozac’s tendency to produce insomnia.
Effexor (venlafaxine hydrochloride) is chemically similar to an antidepressant compound in chocolate known as phenylethylamine (PEA), sometimes associated with the “love effect.” It is likely that PEA raises the level of endorphins in the brain, which creates a sense of well-being. The tradition of giving chocolates on Valentine’s Day reflects our intuitive knowledge of this effect.
As of April 2, 2010, fluoxetine is one of four antidepressant drugs that the FAA allows pilots to take. The others are sertraline (Zoloft), citalopram (Celexa), and escitalopram (Lexapro).
In the US, a survey of drug companies found that between 1995 and 1999, use of Prozac-like drugs for children aged seven to 12 increased by 151 per cent, and in those aged under six by 580 per cent. In 2004, children aged five and under were America’s fastest-growing segment of the non-adult population using antidepressants. ‘Selective mutism’ (fear of speaking in social situations) is one affliction common in preschoolers and has been treated with Prozac.
A small number of children, teenagers, and young adults (up to 24 years of age) who took antidepressants (‘mood elevators’) such as fluoxetine during clinical studies became suicidal (thinking about harming or killing oneself or planning or trying to do so). Children, teenagers, and young adults who take antidepressants to treat depression or other mental illnesses may be more likely to become suicidal than children, teenagers, and young adults who do not take antidepressants to treat these conditions. However, experts are not sure about how great this risk is and how much it should be considered in deciding whether a child or teenager should take an antidepressant.
Use in the Elderly
Fluoxetine is generally not recommended for use in the elderly because of its long half-life and prolonged side effects.
Roughly 19.49 million prescriptions for this drug were filled in 2009, 24.4 million in 2010, and the number increased to over 24.5 million prescriptions in 2011. Prozac was considered the very first SSRI (Selective Serotonin Reuptake Inhibitors) medication to hit the market and was approved in 1987. It is widely regarded as the most popular antidepressant and some would consider “Prozac" to antidepressants as “Coke" is to soda. In addition to being approved for major depression, it is also used for OCD, eating disorders, and trichotillomania.
You’ve probably heard about all the prescription meds in our water supply. Turns out Prozac in public waters makes shrimp act nutty—and not in a good way.
Seems that the active ingredient in antidepressants like Prozac boosts serotonin in the shrimps’ nervous system and make them wiggle away from safe, dark waters toward the light, where they’re more likely to be devoured by predators.
And because researchers don’t think Prozac has the same mood-elevating effect in shrimp as it does in people, the crustaceans don’t even get to die happy.
Prozac, an antidepressant that revolutionized the medical landscape, can cause birth defects if taken during pregnancy and can increase suicidal thoughts and behavior in children and young adults. Patients have targeted Eli Lilly & Co., drug manufacturer, with numerous Prozac lawsuits, claiming the company didn’t properly warn them about the drug’s dangerous side effects.
Eli Lilly paid more than $50 million by 2000 to settle dozens of lawsuits related to Prozac. The drug remains on the market, although the FDA now requires it to carry a black-box label warning stating that it may increase suicidal thoughts or behavior in young people. So far, the company has refused to admit liability in birth defect cases.