Fluoxetine is a medication in selective serotonin reuptake inhibitor (SSRI) family. Common brand name of this drug is Prozac®. It is mainly prescribed for major depression, obsessive compulsive disorder and anxiety disorders.
How fluoxetine acts?
Selective serotonin reuptake inhibitors act by inhibiting serotonin reuptake pumps in certain neuronal synapses. Inhibition of reuptake increases the levels of serotonin in those nerve endings. Increased serotonin initiates a cascade of reactions which ultimately results in the therapeutic action. Increased serotonin levels in unfavorable regions results in the side effects.
What are the common conditions Fluoxetine prescribed for?
Fluoxetine is most commonly used in clinical depression. Depression is characterized by persistent low mood, lack of enjoyment in life, suicidal thoughts and sleep problems. For depression, this medication must be taken for more than two weeks to see an effect. But side effects such as tremors and insomnia occurs early and they usually wane after two to three months. Usual starting dose is 20mg in the morning. In addition, this medication should not be taken in the night due to sleep problems.
Fluoxetine is also prescribed in anxiety disorders such as generalized anxiety disorder. But it is usually prescribed in addition to the psychological treatment. In addition, it also takes around two to three weeks to act. Usually to cover that window doctors prescribe benzodiazepines. They are known to act quickly, but is habit forming in long term use.
Obsessive compulsive disorder
This disorder is characterized by persistent useless repetitive thoughts, rituals and actions. Patients know that these are their own actions and they internally resist them. In addition, they are usually causing tremendous suffering to the patient. E.g. Religious person may get repetitive blasphemous thoughts, which causes distress to the patient.
Fluoxetine is prescribed in this condition. But to be effective, there should be psychological treatment methods in addition to the drug management. Compared to the response seen in depression, obsessive compulsive disorder is relatively resistant to the treatment.
Panic disorder is characterized by sudden onset feeling of doom, increased heart rate and shortness of breath. Fluoxetine is effective in this disorder and as mentioned earlier, it is also co prescribed with psychological treatment methods.
Increased suicidal risk?
Even though this is an anti-depressant, this medication is known to increase suicidal risk in susceptible individuals. Usually depressed people tend to have lack of energy. It prevents them from harming themselves. Fluoxetine increases energy level in the patient before relieving depression. This is the main cause for increased suicidal risk.