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Prozac Addiction

Posted on January 25, 2013 in Prescription Drug Addiction

Prozac AddictionIt boggles the mind to think about how much Prozac is in the world and how many people are taking it. As one Harvard doctor said, “The numbers are astounding.” In the first year it came out, Prozac generated almost 2,500,000 prescriptions, and just four years later, that number had grown to 33,000,000. Even with competition from similar but newer antidepressants, Prozac ranked fifth among all psychiatric medications in 2011. Almost one in four women between 40 and 60 years old and 14% of all non-Hispanic whites in the United States are taking an antidepressant like Prozac, which adds up to over 205,000,000 prescriptions per year.

In Montréal, where one in four people are taking similar antidepressants, the Prozac runoff into sewage water is starting to affect the fish population.

What Is Prozac?

In 1951, doctors were experimenting with a drug called Iproniazid to treat tuberculosis in patients at Staten Island hospital. To the surprise of the researchers, the patients became happy and energetic, and had improved appetites. Since Iproniazid is a monoamine oxidase inhibitor that increases the levels of serotonin in the brain, this marked the discovery of the first of this new category of anti-depressant. Serotonin is a chemical released during moments of pleasure.

Flash forward to 1974 – to a laboratory in the Eli Lilly pharmaceutical company, where two chemists are discovering fluoxetine, which was later introduced as Prozac in 1988. Two similar drugs, Zoloft and Paxil, appeared in the next two years, and these three became the first “Selective Serotonin Uptake Inhibitors (SSRIs), or drugs that stop serotonin from going back into their nerve cells of origin. By inhibiting reuptake, serotonin or the “feel good” chemical increased in the brain.

The new SSRIs revolutionized the way people thought about depression. Hamlet did not have melancholy — he had a chemical imbalance in his brain. If your wife died, you weren’t in grief — you had a chemical imbalance in your brain that Prozac could cure. What’s more, Prozac could even help you lose weight. Overnight the drug became chic, and anyone who thought it was cheating to pop a pill for depression was “Calvinistic, uptight or uninformed. As Dr. Peter Kramer put it, “Prozac could clear up compulsiveness and sensitivity to loss and rejection, altering people pharmacologically.”

Prozac also revolutionized treatment of depression by moving it out of the psychiatrist’s office and over to the family physician’s. Primary care physicians now treat nearly all cases of depression, and today fewer than one in three of the people taking Prozac report seeing a mental health professional in the past year. From this new medical point of view, taking Prozac for depression is the same as taking Lipitor for high cholesterol.

Very recently, however, a Prozac counter-revolution has been rumbling. Prozac and other SSRIs are supposed to work by increasing serotonin levels, so it would follow that the brains of depressed people would have lower levels of the “feel good” chemical. In 1987 scientists performed autopsies on the brains of people who died with and without depression, and they could find very few differences in their serotonin levels.

In 2003 scientists at Columbia University, looking for a new cause of depression in laboratory animals, found out that stressed-out mice did not produce new nerve cells in an area of the brain called the hippocampus. Depression therefore could be a kind of brain atrophy in which brain cells shrink and die with sadness as just one symptom of the disease. SSRIs seemed to make brain cells regenerate in depressed laboratory animals, which is probably why that it can take up to a month for these drugs to take effect in humans.

This theory could also explain why Prozac may work only for the most severely depressed patients.

In 1994, a study published in the Journal of Mental and Nervous Diseases indicated that Prozac produced only modest effects when compared to placebos (sugar pills). 1997 Dr. Irving Kirsch of Hull University used legal means to request suppressed studies of Prozac and found the drug did not perform any better than placebos. In 2008, a large meta- analysis of all previous studies of Prozac appeared in the Library of Public Science. This research team concluded that the drug’s overall effect is “below criteria for clinical significance.” Immediately Prozac’s manufacturer claimed this new study was flawed. In 2010, another study found that patients with mild or moderate depression had only small benefits from Prozac but patients with severe depression had significant benefits from the drug.

What Are The Medical Uses Of Prozac?

Doctors prescribe Prozac for major depressive disorder, bulimia nervosa, obsessive compulsive disorder, panic attacks, and premenstrual dysphoric disorder. It can be used with Zyprexa to treat bipolar disorder after at least two other medications had been tried and failed. Prozac is sometimes prescribed to treat alcoholism, headaches, attention deficit disorder, borderline personality disorder, sleep disorders, posttraumatic stress syndrome, Tourette’s syndrome, obesity, and phobias.

Prozac comes as a tablet, capsule, a delayed release capsule, a solution, and a syrup. You only need to take Prozac Weekly every seven days, but most people take Prozac once or twice a day. The usual dose for adults is one 20mg capsule per day for depression, bulimia, obsessive compulsive disorder, and premenstrual dysphoric disorder. For bulimia, however, 60mg is the usual beginning dose.

Prozac is not prescribed to people with histories of suicide attempts or drug abuse, kidney diseases, cirrhosis, epilepsy, glaucoma, diabetes, mania, low-sodium disorders, or those undergoing electric shock therapy for depression. It is not usually prescribed to pregnant women because it increases the risk of prematurity and persistent pulmonary hypertension in their infants, and is even associated more recently with other birth effects, including autism, according to an article in the Archives of General Psychiatry.

Doctors prescribe Prozac to children as young as seven years old.

Prozac is relatively cheap — perhaps 50 cents to $1 a capsule, and readily available through illegal Internet pharmacies.

What Are The Side Effects Of Prozac?

Because so many people have taken Prozac, hundreds of side effects have been reported but not documented in scientific studies. People on Prozac have complained about everything from color blindness to being violent with others. Some people do have very serious side effects and have to stop using Prozac. These might be severe blistering and peeling of the skin, red rashes, rigid muscles, high fever, sweating, fast heartbeats, tremors, overactive reflexes, severe nausea, vomiting, diarrhea, unsteadiness and loss of coordination, hallucinations, fainting, seizures, or even comas.

One of the most difficult side effects of Prozac can be sexual dysfunction, such as delayed orgasms and reduced sex drive in both men and women, and impotence in men.

Several less serious side effects, particularly drowsiness, are extremely common. Some people cannot take Prozac and drive automobiles because of impaired coordination and drowsiness. Other side effects are dizziness, dry mouth, shaking of a part of the body, nervousness, restlessness, nausea, upset stomach, trouble concentrating, memory problems, confusion, constipation, increased appetite, weight gain or weight loss, sleep problems, headache, low sodium levels, abdominal pain, increased frequency of urination, and blurred vision.

Sometimes people who have the most severe side effects have the best results from Prozac.

What Are The Risks Of Taking Prozac?

The main risk of taking Prozac comes within the first weeks of using it. The drug may actually increase the likelihood that a depressed person, especially someone under 25 years old, will feel worse and even commit suicide. Studies of over 2200 children indicated that children taking SSRIs had double the number of suicidal thoughts and behaviors compared to children taking placebos.

In 2004, after Prozac had been on the market for 16 years, the U.S. Food and Drug Administration issued a black box warning — the most serious action the agency can take short of pulling a drug off the market. The new required label warns parents and physicians that children and young people taking SSRIs like Prozac have an increased risk for suicidal thoughts and behaviors and should be monitored carefully, especially in the first few weeks of medication. In 2006, the FDA included all patients under 24 years old in the warning. After the black box warning appeared, the suicide rate for young people actually went up. Studies of these suicides concluded that some of these adolescents suffering from depression should have been helped by SSRIs, but the black box warning deterred parents and physicians from using the drugs as frequently as before the warning. The National Institute of Health researchers concluded that the benefits of these drugs outweigh the risks even for young people.

Many people taking Prozac complain that they experience “crazy” or even homicidal thoughts, especially when they first start taking it. Notorious news stories about “Prozac murderers” have appeared all over the world. In one such 2009 case, after a Canadian teenager stabbed a friend to death, his lawyers argued that taking Prozac for three months had pushed the killer over the edge. The judge agreed, noting that “(the killer’s) mental deterioration and resulting violence would not have taken place without exposure to Prozac.”

The judge’s ruling remains controversial. The problem with blaming Prozac is that some people taking it and other similar anti-depressants probably have serious but undiagnosed mental illnesses, so it becomes impossible to tell whether a homicidal act is the product of a drug or an illness. In addition, millions of people are using these drugs, and no one can predict any one individual’s response to them.

Since Prozac has only been on the market since 1988, no one knows the effects of taking it for thirty years or more. However, many people remain on the drug for many years even though they might have begun taking it for a singular crisis, such as the death of a loved one. Effects such as Prozac’s long-term impact on young adult sexuality have not been sufficiently studied. Dr. Peter Kramer, author of Listening to Prozac, has noted that Prozac is associated with damage to bodily organs, heart arrhythmia, inflammation of the liver, and thyroid dysfunction.

A few people have life-threatening allergic reactions to Prozac, especially the extended-release capsules used once a week. Symptoms can be hives, rashes, difficulty breathing, tightness in chest, swelling of the face, tongue and lips, and hoarseness. Seek immediate medical attention for such a reaction.

Prozac can cause a life-threatening syndrome called “serotonin syndrome” if taken in conjunction with certain other drugs. See the drug interactions section below.

What Drugs Interact With Prozac?

If you are taking a monoamine oxidase inhibitor (MAOI), then you have to wait two weeks before you take Prozac. You have to wait five weeks after stopping Prozac before you can take an MAOI. Common MAOIs are Nardil, Parmate, Furoxone, Marplan, and Emsam. This combination can lead to coma and death. Other serious and even fatal reactions occur if you take Prozac with Mellaril and Orap or certain migraine headache medications like Axert, Frova, Imitrex, Treximet, Amerge, Maxalt, or Zomig.

If you take Prozac with other drugs that increase serotonin levels in the brain, you run the risk of serotonin syndrome, which can be fatal. SSRIs, such as Zoloft or Paxil, and other drugs such as lithium, St. John’s wort, narcotic painkillers, and tryptophan that increase serotonin levels should not be combined with Prozac.

Prozac increases the risk for bleeding problems, and should not be combined with drugs that do the same thing such as aspirin, Advil, ibuprofen, naproxen, Celebrex, and Coumadin. Do not combine Prozac with sedatives, sleeping pills, tramadol, insulin or other diabetes medicines, tranquilizers, Plavix, Clozaril, Fazacio, Tambocor, Haldol, Velban, and anti-seizure drugs including Dilantin, Cabatrol, Equetro, and Tegretol without a doctor’s knowledge.

What Is A Prozac Overdose?

A potentially fatal reaction can occur if you take too much Prozac. Symptoms of overdose are confusion, unresponsiveness, unsteadiness, uncontrollable shaking of a part of the body, pounding heartbeat, hallucinations, nervousness, confusion, fever, fainting, and finally losing consciousness. Some people will experience difficulty in focusing their eyes, feeling that they are constantly moving, high or low blood pressure, delusions, loss of bladder control, muscle stiffness, unusual body or facial movements, pale skin, and sleepiness. If you suspect that you or someone else is having a Prozac overdose, seek emergency medical help as soon as possible.

Prozac Discontinuation (Withdrawal) Syndrome

The United States government does not classify Prozac as an addictive substance subject to controls and regulations that apply to controlled substances like cocaine, heroin, and so forth. Nevertheless, Prozac shares one characteristic of all addictive drugs: it can cause a withdrawal syndrome usually called “Prozac discontinuation syndrome.”

About one in five patients will experience the syndrome, especially if they have taken Prozac for six or more weeks and stop cold turkey. Children and young adults may have the most severe withdrawal symptoms.

Withdrawal symptoms that can affect the nervous system include vertigo, lightheadedness, tingling, imbalances, blurred vision, restless legs, anxiety, irritability, burning in certain body parts, blurred vision and flashing lights, ears ringing, tremors, restlessness, and hallucinations. Some people have crying spells and nightmares. Other symptoms can be like the flu and include nausea, sweating, headaches, appetite increase or decrease, hot flashes, and muscle pains. Some people experience the “lightning bolt phenomenon” in which they have shockwaves in their arms and legs.

Within eight hours of the last dosage, withdrawal symptoms appear and may take as long as two months to completely stop. This is why most doctors recommend that patients gradually taper off their dosage of Prozac instead of quitting cold turkey. If you choose to taper off under a doctor’s supervision, the riskiest period comes at the end when even small increments can have a big impact on serotonin levels. Your doctor should have you taper off more slowly at the last part of withdrawal that at the beginning. Once you have completely stopped using Prozac using this method, withdrawal symptoms may persist for two more weeks.

Prozac is considered non-addictive, so once your withdrawal is over, you will not experience drug cravings. The Prozac withdrawal syndrome is only moderate compared with short-acting SSRIs like Paxil. Prozac remains in the body a long time and leaves the body slowly. Doctors often switch patients to Prozac from Paxil and other drugs with more difficult withdrawals, and then gradually taper off the Prozac.

How Can You Decide Whether to Stop Taking Prozac?

The problem many people have when they want to discontinue Prozac is resistance from their doctors. The attitude of Dr. Thomas Bent, president of the California Academy of Family Physicians, is typical of most doctors when he says, “As soon as our patients feel better, they start asking ‘How long do I have to take this drug?’ They don’t think that way about their blood pressure medicines.”

Even if a doctor is supportive of a patient’s discontinuation of Prozac, the patient may develop severe withdrawal syndrome, which can be traumatic and easily remedied by taking more Prozac, so the patient often returns to the pills. In other cases, after the patient stops using the drug, the old depression comes back with a vengeance and the patient develops suicidal thoughts and behaviors. In these cases, it would be appropriate to go back to taking anti-depressants and to seek psychotherapy. Each person is different, and each person’s experience with Prozac is highly individual. This is why it is necessary to discontinue Prozac only under medical supervision.

If you are determined to stop using Prozac, the first thing to do is to examine the reasons why you want to discontinue it. Some patients want to stop because they are experiencing difficult side effects or because they are afraid of long-term effects of the drug. Others who may have started on the drug because of a personal crisis, such as losing their jobs, want to find out if they have sufficiently recovered emotionally from the original loss so as to no longer need the drug.

Some people, such as Katherine Sharpe, began the drug in high school or college and are now wondering what parts of their personalities have been altered by antidepressants and how these drugs are affecting their personal growth. In an article in the Wall Street Journal, Sharpe wrote, “Medication melted away my sadness and lifted my despair, but it made me feel damaged, lacking in agency, and cut off from the ability to simply be myself.”

Harvard University’s Dr. Andrew Weil and other renowned physicians believe that drugs like Prozac are overprescribed and should be used only for severe depression resistant to psychotherapy. As Dr. David Ramirez, head of counseling at Swarthmore College, said, “Life is full of stress and anxiety and sadness. Those are just baseline phenomena that have come to be considered illnesses.”

If you are using Prozac along with other mind-altering drugs such as alcohol, marijuana, sleeping pills, or muscle relaxants or if you believe a more holistic approach to your problems could benefit you, you may want to consider entering a drug rehabilitation center where you can make a new beginning. You could withdraw from Prozac or any other drug under careful medical supervision. Your residential center can provide an intensive, supportive community and a holistic approach to depressive disorders that includes psychotherapy, spiritual growth, group counseling, family counseling, stress reduction techniques, physical fitness, and so forth. Residential treatment can present a unique opportunity for self-growth and self-knowledge within a new environment.

Ask Yourself Why You Want To Discontinue Prozac

If you can answer yes to any of the following questions, it is time to consult your doctor or a mental health professional about whether or not you should discontinue taking Prozac and seek professional help for withdrawal and aftercare.

  • Are you experiencing difficult side effects of Prozac that interfere with your everyday life?
  • Do you think Prozac is not working as well for you as it did in the beginning?
  • Are you taking illegal drugs or alcohol along with Prozac?
  • Have you tried to stop taking Prozac on your own and failed?
  • Do you enter difficult withdrawal syndrome when you stop taking Prozac?
  • Have you been taking Prozac for a long time?
  • Do you think you could benefit from psychotherapy?
  • Are you having problems in relationships that you endure rather than try to solve?
  • If money were no object, would you enter a residential treatment center?
  • Do you feel that you have too much stress in your life and no way to handle it?

Source:

Wehrwein, Peter. “Astounding Increase In Antidepressant Use By Americans,” Harvard Health Publications, October 20, 2011.

Mukherjee, Siddhartha. “Post-Prozac Nation,” The New York Times, April 12, 2012.

André Lajeunesse, Christian Gagnon, François Gagné, Séverine Louis, Patrick Čejka, Sébastien Sauvé. Distribution of antidepressants and their metabolites in brook trout exposed to municipal wastewaters before and after ozone treatment – Evidence of biological effects. Chemosphere, 2011; DOI: 10.1016/j.chemosphere.2010.12.026

Mukherjee, Siddhartha. “Post-Prozac Nation,” The New York Times, April 12, 2012.

Rimer, Sara. “With Millions Taking Prozac, A Legal Drug Culture Arises,” The New York Times, December 13 1993.

Kramer, Peter. Listening to Prozac (New York: Viking) 1993.

Wehrwein, Peter. “Astounding Increase In Antidepressant Use By Americans,” Harvard Health Publications, October 20, 2011.

Mukherjee, Siddhartha. “Post-Prozac Nation,” The New York Times, April 12, 2012.

Lehrer, Jonah. “How Prozac Sent Science of Depression in the Wrong Direction,” The Boston Globe, July 6, 2008.

Goleman, Daniel. “New View of Prozac: It’s Good But It’s Not a Wonder Drug,” The New York Times, October 19. 1994.

Mukherjee, Siddhartha. “Post-Prozac Nation,” The New York Times, April 12, 2012.

Ibid.

“Prozac,” PsychCentral, see http://forums.psychcentral.com/meds/prozac.html

“Prozac,” Drugs.com, see http://www.drugs.com/prozac.html

“Fluoxetine,” The U.S. National Library of Medicine, The National Institute of Health, PubMed, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/

“Fluoxetine,” The U.S. National Library of Medicine, The National Institute of Health, PubMed, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/

“Fluoxetine, Oral Route,” The Mayo Clinic, see http://www.mayoclinic.com/health/drug-information/DR600689

“Prozac,” Drugs.com, see http://www.drugs.com/prozac.html

“Fluoxetine, Oral Route,” The Mayo Clinic, see http://www.mayoclinic.com/health/drug-information/DR600689

“Prozac,” The National Alliance for Mental Illness, see http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=51&ContentID=66294

“Prozac,” Drugs.com, see http://www.drugs.com/prozac.html

Goleman, Daniel. “New View of Prozac: It’s Good But It’s Not a Wonder Drug,” The New York Times, October 19. 1994.

“Fluoxetine, Oral Route,” The Mayo Clinic, see http://www.mayoclinic.com/health/drug-information/DR600689

“Prozac,” Drugs.com, see http://www.drugs.com/prozac.html

“Prozac,” The National Alliance for Mental Illness, see http://www.nami.org/Template.cfm?Section=About_Medications&Template=/TaggedPage/TaggedPageDisplay.cfm&TPLID=51&ContentID=66294

Goleman, Daniel. “New View of Prozac: It’s Good But It’s Not a Wonder Drug,” The New York Times, October 19. 1994.

“Antidepressant Medications for Children and Adolescents: Information for Parents and Caregivers,” The National Institute of Health, http://www.nimh.nih.gov/health/topics/child-and-adolescent-mental-health/antidepressant-medications-for-children-and-adolescents-information-for-parents-and-caregivers.shtml

Ibid.

Ibid.

McIntyre, Mike. “Judge Agrees Prozac Made Teen a Killer,” The Winnipeg Free Press, September 17, 2011.

Sharpe, Katherine. “The Medication Generation,” The Wall Street Journal, June 29, 2011.

Kramer, Peter. Listening to Prozac (New York: Viking) 1993.

“Prozac Delayed-Release Weekly Capsules,”  Drugs.com, see http://www.drugs.com/cdi/prozac-weekly-delayed-release-capsules.html

“Prozac,” Drugs.com, see http://www.drugs.com/prozac.html

“Fluoxetine, Oral Route,” The Mayo Clinic, see http://www.mayoclinic.com/health/drug-information/DR600689

“Prozac,” Drugs.com, see http://www.drugs.com/prozac.html

“Fluoxetine,” The U.S. National Library of Medicine, The National Institute of Health, PubMed, see http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000885/

“Fluoxetine, Oral Route,” The Mayo Clinic, see http://www.mayoclinic.com/health/drug-information/DR600689

“Anti-Depressant Withdrawal,” The Web MD, see http://www.webmd.com/depression/guide/withdrawal-from-antidepressants

Elliot, Victoria. “The Long Good-bye,” American Medical Association News, March 3, 2009, see http://www.ama-assn.org/amednews/2009/03/09/hlsa0309.htm

” Prozac,” Livestrong Association, see http://www.livestrong.com/fluoxetine-prozac/

Duenwald, Mary.  “How to Stop Depression Medications: Very Slowly,” The New  York Times, May 25 ,2004.

Ibid.

“Prozac,” Livestrong Association, see http://www.livestrong.com/fluoxetine-prozac/

Duenwald, Mary.  “How to Stop Depression Medications: Very Slowly,” The New  York Times, May 25 ,2004.

Elliot, Victoria. “The Long Good-bye,” American Medical Association News, March 3, 2009, see http://www.ama-assn.org/amednews/2009/03/09/hlsa0309.htm

Sharpe, Katherine. “The Medication Generation,” The Wall Street Journal, June 29, 2011.

Ibid.

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