What is Fluoxetine and What are the Side Effects?

An estimated 17.3 million American adults, or 7.1 percent of the population, experienced a major depressive episode in 2017, according to the National Institute for Mental Health.

People who suffer from serious depression or major depressive disorder may turn to help from medications like fluoxetine in hopes of relieving their symptoms, in conjunction with talk therapy and lifestyle changes.

Fluoxetine is the generic form of Prozac, one of the most widely recognized depression medications on the market today, but what is fluoxetine and what are the side effects?  

What is Fluoxetine?

Fluoxetine is the generic form of Prozac, which was the first drug introduced in a class of medications called selective serotonin reuptake inhibitors (SSRIs).

SSRIs like fluoxetine are used to treat mental illnesses like depression and anxiety, among other mental health conditions. 

Fluoxetine was approved by the U.S. Food and Drug Administration (FDA) under the brand name Prozac in 1986, and it’s status as the first medication in a new class of antidepressants has since made it a household name.

Nearly 22 million prescriptions were written for fluoxetine in 2017, making it one of the most popular SSRIs on the market.

What is Fluoxetine Used to Treat?

After its approval for the treatment of clinical depression in 1986, fluoxetine has since been approved for the treatment of many other mental health conditions, including major depressive disorder (MDD), panic disorder, bulimia nervosa, obsessive compulsive disorder (OCD), and premenstrual dysphoric disorder (PMDD).

A brief explanation of each of these conditions and their associated symptoms is provided below.

Clinical Depression/Major Depressive Disorder

When most people think of depression, they are picturing the symptoms of clinical depression, also known as major depressive disorder.

Clinical depression is caused by persistent and intense feelings of sadness that continue for long periods of time. In addition to impacting your mood and behavior, depression can cause physical symptoms that impact your sleep habits and appetite. 

People with major depressive disorder often have trouble performing daily activities and tasks, lose interest in doing things they once enjoyed, and may exhibit suicidal thoughts or behaviors.

An episode of depression impacts an estimated seven percent of American adults each year. 

Symptoms of major depressive disorder include:

• Lost of interest in activities you used to enjoy
• Difficult concentrating and low energy
• Feeling sad, empty, or tearful
• Feelings of worthlessness, guilt, hopelessness, or helplessness
• Feelings of moving or thinking in slow motion
• Suicidal thoughts or behaviors
• Sleeping and eating more or less than usual
• Nervous energy

Obsessive Compulsive Disorder

Obsessive compulsive disorder, or OCD, is a mental illness that is characterized by obsessive, worrisome thoughts that cause anxiety.

People with OCD perform compulsive behaviors in order to relieve the anxious thoughts, which may center around  the loss of a loved one.

Compulsions associated with OCD manifest themselves in different ways for each person, but one notable constant is that people with the condition feel compelled to perform the behaviors even when they do not want to or it is inconvenient.

Obsessive compulsive disorder is often first diagnosed in childhood or early adulthood and intensifies later in life. Symptoms include:

• Need for symmetry and order, including obsessive cleanliness
• Feeling that you can protect other people by performing certain behaviors or rituals
• Anxiety about germs and dirt
• Fear of contamination
• Difficulty throwing away things of little to no value (hoarding tendencies)
• Disturbing thoughts 

People with obsessive compulsive disorder may experience some of the following symptoms:

• Hoarding unnecessary possessions of little value
• Rearranging things continuously to get them “just right”
• Excessive hand washing, showering, or repetitive cleaning
• Checking things over and over again, such as making sure the door is locked

Panic Disorder

Panic disorder is a type of anxiety disorder in which a person suffers from unexpected and repeated episodes of intense fear that results in physical symptoms.

Panic disorder causes physical symptoms that when combined are called panic attacks; symptoms include shortness of breath, heart palpitations, chest pain, sweating, dizziness, and nausea.

Bulimia Nervosa

Bulimia nervosa is an eating disorder that is characterized by binging and purging (eating an unusually large amount of food, often in a short amount of time, past the point of fullness and then purging the food to prevent weight gain).

Common purging methods include laxative abuse, induced vomiting, or excessive exercise.

Premenstrual Dysphoric Disorder

Premenstrual dysphoric disorder (PMDD) is a mental illness that features extreme experiences of depression, tension, and irritability prior to menstruation.

While many women experience mild forms of these symptoms before menstruation, women with PMDD experience extreme forms. 

What are the Benefits of Using Fluoxetine?

Fluoxetine is the first SSRI introduced to the market, and since its invention, many new SSRIs have been added.

However, the medication offers many benefits and remains one of the most popular SSRIs on the market despite the competition. Benefits associated with the use of Fluoxetine include:

• The medication is shown to be effective at treating a wide range of mental health conditions, including panic disorder, bulimia nervosa, major depressive disorder, obsessive compulsive disorder, and premenstrual dysphoric disorder. Individuals who have been diagnosed with more than one of these conditions may be able to receive treatment with just one medication.  
• People with naturally low energy levels or those who are experiencing low energy as a result of their depression may find that fluoxetine increases their energy levels.
• People who have their energy levels increased when taking fluoxetine may experience easier weight loss, which is helpful for those who are overweight. 
• Fluoxetine is better tolerated by older adults than other SSRIs because it does not carry the risk of adverse effects associated with the heart.
• Children with major depressive disorder or obsessive compulsive disorder can be treated safely with fluoxetine.

How Do I Know What Dose of Fluoxetine to Take?

The right dose of fluoxetine  will be determined by your health care professional based on your age and the purpose of treatment.

Many people taking fluoxetine and other SSRIs need to have their dosage adjusted several times before finding the appropriate dose. 

Adults suffering from major depressive disorder generally take 20 mg of fluoxetine each morning to begin treatment.

Doctors may increase your dose by 20 mg every few weeks as needed, but most people take between 20 and 60 mg per day. It is not recommended to exceed 80 mg per day of fluoxetine.

Some people prefer to take the delayed release version of fluoxetine, which is taken weekly. When taking the delayed release oral capsule, patients will take one 90 mg capsule per week.

The effects of Fluoxetine are normally experienced in about four weeks.

Fluoxetine can cause withdrawal symptoms if  the dose is changed or the medication is stopped abruptly, especially if the patient has been taking the medication for six weeks or more, so it is important that patients do not stop taking fluoxetine or change their dose without receiving guidance to do so from their healthcare provider.

Symptoms of withdrawal include:

• Nightmares and insomnia
• Vertigo
• Nausea
• Aggression
• Dizziness
• Confusion
• Flu-like symptoms
• Anxiety
• Tremors
• Gastrointestinal issues (diarrhea, nausea)
• Agitation
• Irritability

What are the Side Effects of Fluoxetine?

Possible Side effects associated with Fluoxetine generally fall into two categories: common and rare/serious.

Common side effects associated with Fluoxetine include:

• Diarrhea
• Dry Mouth
• Increased sweating
• Headache
• Nausea
• Sexual dysfunction, such as difficulty with orgasm or ejaculatory delay
• Fatigue
• Drowsiness
• Feeling nervous
• Restlessness
• Difficulty sleeping (insomnia)
• Decreased libido (sex drive)
• Loss of appetite

Rare but serious side effects associated with fluoxetine include:

• Low sodium blood levels, as evidenced by:
  • Difficulty concentrating
  • Headache
  • Weakness
  • Difficulty remembering
• Angle closure glaucoma, as evidenced by:
  • Swelling or redness in or around eye
  • Eye pain
  • Changes in vision
• Risk of serotonin syndrome, as evidenced by:
  • Confusion
  • Severe muscular tightness
  • Shivering
  • Diarrhea
  • Fever
  • Seizures
• QT prolongation and ventricular arrhythmia including changes in the electrical activity of your heart
• Teeth grinding

If you experience allergic reactions such as hives or difficulty breathing, seek medical advice immediately.

Who Should Not Take Fluoxetine?

People who take certain types of medications known to cause dangerous drug interactions with fluoxetine, including drugs metabolized by CYP2D6, tramadol, fentanyl, St. John’s Wort, tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), especially methylene blue, phenelzine, pimozide, isocarboxazid, and thioridazine, benzodiazepines, antipsychotic drugs, anxiolytic drugs, or other SSRIs/SNRIs including but not limited to olanzapine, citalopram, sertraline, tranylcypromine, venlafaxine, amitriptyline, buspirone, diazepam, NSAIDs including ibuprofen, and blood thinners should not take fluoxetine.

People who are allergic to fluoxetine should not take the medication.

Some other groups of people should also use caution when taking fluoxetine. Be sure to give your doctor a complete medical history, especially including any personal or family history examples of:

• Liver problems
• Diabetes
• Bipolar disorder or manic-depressive disorder
• Personal or family history of suicide attempts
• Seizures
• Stomach/intestinal ulcers
• Low sodium in the blood
• Severe loss of body water/dehydration
• Glaucoma (angle-closure type)

Older adults may be at an increased risk of side effects when taking fluoxetine, especially bleeding and loss of coordination. The increased risk of loss of coordination corresponds to an increased risk of falling, which can be serious and even fatal for the elderly. Older adults are also at increased risk of developing low blood sodium.

References, Studies and Sources:

https://www.nimh.nih.gov/health/statistics/major-depression.shtml

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia

https://www.healthline.com/health/depression/effects-brain

https://www.medicalnewstoday.com/articles/263773