Health News and Information

Prozac is a particularly beneficial treatment for:

• patients who are sensitive to side effects of medications in general, and especially the side effects of tricyclic antidepressants and MAOIs

• patients who dislike taking pills, since Prozac can be taken as one pill a day or in liquid form rather man the three to six capsules a day often needed with the tricyclics and MAOIs

• patients who have tried to overdose on other antidepressant drugs

• patients with cardiovascular disease, since Prozac’s effects on blood pressure and the electrocardiogram appear to be minimal (however, patients with unstable heart disease and recent myocardial infarction were not included in early studies).

What has been the major impact of Prozac on the treatment of depression, manic depression, dysthymic and personality disorders? Because the clinical efficacy of Prozac in depression is at least equal to the standard antidepressants, and because the side effects of Prozac are so much milder, the major impact of Prozac has been that patients, families, and physicians have preferred it and the newer drugs to most of the previously used drugs. Its safety and efficacy, in combination with the flood of publicity, both good and bad, it has received since it was first introduced to the American market in 1987, have made Prozac the number one best-selling antidepressant in the United States. In 1993, its sales reached $1.2 billion, exceeding the sales of all previously used antidepressant drugs both nationally and internationally.

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Not entirely. In large clinical trials of Prozac, the most commonly felt side effects in adults were nausea (21.2%) and headache (20.3%), while in an open study of a small group of young people; the most frequent side effects were restlessness (27%) and sweating (20%). Drowsiness, dry mouth, tremor, and thinning hair also showed up more frequently in the young people than in adults. Compared to other antidepressants, these side effects were minimal both in young people and in adults.

Another unwanted, sometimes severe, reaction that appears more frequently among young people is mania. A published study described five adolescent girls, all with family histories riddled with major depression and suicide, who developed mania while taking Prozac. Considering the surprising fact that young people who experience serious major depression before the age of 18 almost invariably become bipolar, it is imperative to witch carefully for the development of these symptoms.

The need still exists for carefully controlled clinical studies comparing the responses of children and adolescents to Prozac and other standard drugs. In the meantime, youngsters taking Prozac should be observed closely and frequently by their families, and any side effects should be immediately reported to the psychiatrist.

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An estimated 5 million Americans are afflicted with obsessive-compulsive disorder, a biologically based syndrome whose symptoms are recurrent and intrusive obsessive thoughts and compulsive, time-consuming behaviors that shape and even dominate, the person’s life—even though the patient knows these thoughts and behaviors are irrational. The standard drug for treatment of OCD has long been the tricyclic antidepressant Anafranil (clomipramine), but in July 1993, the Food and Drug Administration unanimously approved Prozac as a treatment for OCD.

Once more, Prozac’s superiority as a treatment for some patients has much to do with its minor side effects. Anafranil, when taken in the high doses required for OCD (200 to 300 mg a day), often produces severe constipation, dry mouth, thirst, urinary problems, and gastrointestinal complaints. These symptoms do not occur with Prozac except an extremely mild form on occasion.

Luvox (fluvoxamine), a recently released SSRI approved for treatment of OCD, appears to be as efffective as Prozac or Anafranil for this condition. Although not FDA approved for depression in the United States, Luvox has been used for depression in Canada and Europe for several years.

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Chronic fatigue syndrome is an elusive disease, difficult to diagnose (in part because some doctors don’t believe it exists) and difficult to treat or certainly to cure. Its primary symptom, overwhelming tiredness, often accompanied by disturbed sleep, can also be an indication of depression. Antidepressants, which boost energy, counteract depression, and may help to straighten out the sleep cycle, are frequently useful, and several studies have found Prozac to be successful in treating CFS.

Reports indicate that Prozac has dramatically alleviated some premenstrual symptoms in a small group of patients. Some of the symptoms of PMS include irritability, weeping, a depressed or changeable mood swinging from high to low within hours or days, and the feeling of wanting to isolate oneself from others and not participate in outside activities. Given Prozac’s highly successful results with dysthymia and depression, it does not seem surprising that premenstrual depression has been reported to be helped considerably by Prozac. However, further studies are needed.

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It depends on your basic temperament and chemistry. Patients who begin taking Prozac when they are both deeply depressed and highly irritable usually find that irritability diminishes or disappears along with the depression. This has the effect of improving their relationships with their spouses, peers, colleagues, and children. Spouses and grown children sitting in my office with their formerly depressed loved ones have often told me how much easier it is to get along now that the crankiness or anger outbursts have faded along with the depression. Of course, many depressed patients are withdrawn rather than angry.

It is another story with patients who have a tendency toward bipolar mood swings with manic highs characterized by irritability, anger, and paranoid delusions rather than by euphoria and grandiosity. If they take Prozac during a depressed phase and have not been previously stabilized on lithium, the hypomanic or manic side of the mood may emerge in the form of these symptoms.

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