Prozac - Dissipate the Symptoms of Depression

Since it was first approved for use in Belgium in 1986, and then in the United States the following year, Prozac has revolutionised the way in which we treat depression. Indeed today it is the mostly widely used anti-depressant in the world. It has been approved and marketed in over 90 countries and used by more than 54 million people worldwide. Prozac has become a household name.
So just what is Prozac and what exactly is it designed to treat?

Well, put very simply Prozac is an anti-depressant that’s used to help alleviate the symptoms of depression. Of course, by the mid 1980’s there were already a number of anti-depressants on the market but the reason that Prozac caused such a stir was that it heralded a new dawn in the development of anti-depressant medication. Prozac was the first Selective Serotonin Reuptake Inhibitor (or SSRI) to enter the market place.

To understand how, as an SSRI, Prozac works in relation to depression, it helps to first of all have some understanding of depression itself and the role that serotonin plays in its development.

What is Depression?

Clinical depression is a medically diagnosable illness although sometimes getting a correct diagnosis is not that easy. Whilst we might say that we’re feeling depressed when we feel a bit down, there is an enormous difference between that sort of feeling and being clinically depressed. Someone suffering from depression may experience a whole host of widely varying symptoms. According to the World Health Organization symptoms of clinical depression may include:-

• Two weeks of an abnormally depressed mood
• Loss of interest or pleasure in activities that used to be enjoyable
• Disturbed sleep
• Loss of confidence
• Low self esteem
• Reduced ability to think
• Changes in appetite and unexplained physical symptoms.

These symptoms can be so severe and so debilitating that the patient is prevented from leading anywhere near their normal life both socially and psychologically.

Unfortunately, no one is yet certain of the exact cause of depression and why someone should develop it. A number of factors may play their part including:

• Stress; Dealing with major life events such as divorce, death of a loved one or loss of a job and/or finding yourself under stress can trigger depression
• Personality type; Those people, for example, who are particularly sensitive, who maintain very negative views on life or who are very anxious are all at greater risk of developing depression. Interestingly, people who are perfectionists or who set the bar very high for themselves are also at risk of experiencing depressive episodes particularly as a result of work or study pressures
• Hereditary link; If someone in your immediate family has suffered from depression or bipolar disorder (manic depression) your own risk of developing a depressive illness increases two or three times
• Ill health; Suffering from another illness, or the drugs used to treat that condition or the stress that comes from being ill, may all lead to depression. Research clearly indicates that, for example, people who experience cancer suffer from higher than average rates of depression

But even though no one is as yet absolutely sure what causes someone to develop depression, what is known is that many sufferers undergo chemical changes in their brains. Indeed, it may even be that it is these changes that actually cause depression in the first place. Regardless of whether it’s these changes in the brain that cause depression or depression that causes the changes, the fact that there are chemical changes led to the development of what is known as the monoamine hypothesis of depression and to the development of Prozac.

The Development of Prozac

The chemical changes in the brain occur in relation to the brain’s supply of certain neurotransmitters. Neurotransmitters enable brain cells (neurons) to communicate with one another. Neurons are connected to each other via synapses. There are two distinct forms of synapse - an electrical one where two neurons actually touch each other or a chemical synapse where a minute space called a synaptic gap exists between the neurons. The vast majority of synapses in the human brain are chemical ones. To enable nerve impulses to travel from neuron to neuron across synaptic gaps, neurons release special chemicals (neurotransmitters) which allow the nerve impulses to safely cross the synaptic gaps.

Researchers discovered that when someone is clinically depressed, they are deficient in certain neurotransmitters which belong to a group of chemicals called monoamines – hence the term ‘the monoamine hypothesis of depression’. By boosting levels of these neurotransmitters, a patient’s symptoms of depression could be relieved and ‘normal function’ restored.

As you can imagine this breakthrough in our understanding of the biological processes involved in depression has been crucial, particularly with regard to the treatment of the disease although it is still not known for sure whether monoamines are the primary cause of depression, or whether other factors are causing both the lowered neurotransmitter levels and the depression.

A number of different monoamines - serotonin, noradrenaline and dopamine - are thought to be implicated in the development of depression, with each one of them playing a specific role. Serotonin is known to be involved in the regulation of emotions, sleep and appetite and it is believed that depleted serotonin levels, in particular, are an important factor in the development and severity of depression.

Prozac works by helping to correct the imbalance in serotonin levels that play such a crucial part in depression. It does this by increasing the brain's own supply of the neurotransmitter by preventing serotonin from being re-absorbed. And it’s because of its specificity in only affecting serotonin, that it is called an SSRI.

The effect of increasing the brain’s supply of serotonin helps dissipate the symptoms of depression. This makes the sufferer feel better and allows them to return to living a normal life. It should be remembered, however, that Prozac is not a cure for depression but is instead a way of managing and controlling the symptoms of the disease.

The Prozac Treatment Phases

Although Prozac can really help when it comes to dealing with the symptoms of depression, it is no quick fix. It takes time for Prozac to work and provide the relief that is needed. In most cases, it takes at least 4 weeks of Prozac therapy before the full affects of the medication are felt. The total period of treatment is divided into two very distinct phases - the acute phase and the continuation phase.

The Acute Phase

The first few weeks of treatment, before the benefits of treatment are felt, are known as the acute phase. They can be particularly tough going. Not only is your body getting used to Prozac, but you will still be suffering from the symptoms of depression.  Even very minor side effects at this stage can seem huge and you may feel that rather than feeling better, you are simply adding to your problems. The temptation to give up on the Prozac therapy may therefore be very great. It’s a good idea to seek as much support as possible to help you through the acute phase because it is really important that you continue taking Prozac. After a few weeks you will really start to see the benefit of the medication.

The Continuation Phase

Once through the acute phase, you will enter the continuation phase of treatment. By now you should be feeling much better as the full effects of the Prozac therapy are felt. The continuation phase is aimed at preventing relapse and usually lasts anywhere between 4-9 months after the symptoms of depression have gone away. In general, the length of your original depressive episode will influence the length of the continuation phase.

Regular monitoring by your doctor during treatment is also important in this regard as it is important to follow their advice. If you stop your treatment early because you feel better or because of side effects, you risk experiencing a relapse.

By the end of the continuation phase, full recovery should have been achieved. This means that for most people a complete course of Prozac therapy will last for a total of 6-12 months. However, some people will be advised to continue with Prozac even after they have made a full recovery because they are at high risk of developing depression again.

Consider the following statistics relating to the high reoccurrence rate of depression:

• Once a person has experienced one bout of depression, they have a 50% chance of having another
• With two depressive episodes, the risk of developing depression again increases to 70%
• With three depressive episodes, the risk of recurrence is as high as 90%

Continuing treatment for those at very high risk may help prevent another depressive episode altogether, or at least help to lessen the severity of any subsequent episode.

Prozac and OCD

Prozac may also help in the treatment of those suffering from OCD (obsessive compulsive disorder) and bulimia. OCD is an anxiety disorder that can significantly interfere with normal daily life. It’s characterised by recurrent obsessions (persistent ideas, thoughts, images or impulses) or compulsions that are time consuming or that can cause significant distress and anxiety to the sufferer. Common obsessions include:

• Repeated doubts such as “did I lock the door when I left?” or “did I unplug the iron?”
• The need for orderliness such as getting very distressed if things are untidy or pictures are crooked
• Aggressive impulses including  thoughts of killing your own child or hurting yourself
• Thoughts of contamination such as “will I catch AIDS from shaking hands?”

To try and deal with such intrusive and worrying thoughts and impulses, OCD sufferers feel compelled to voluntarily perform irrational, repetitive, time-consuming behaviours such as washing or checking to diminish their anxiety. They may also perform compulsive mental acts such as silently repeating words over and over again.

Prozac and Bulimia Nervosa

Bulimia nervosa is an eating disorder that is characterized by the sufferer indulging in frequent binge eating episodes followed by compensatory behaviours to rid the body of the food just eaten. The most common form of compensatory behaviour is self induced vomiting which is known as purging. However, compensatory behaviours can and do also include taking large doses of laxatives or diuretics, enemas, fasting and exercising compulsively. Prozac can help in the treatment of Bulimia Nervosa.

Dosage, Side Effects and Warnings

Dosage

Prozac dosage depends upon the condition that is being treated. Your doctor will advise you as to your appropriate dosage. The treatment guidelines are:

• For depression; The recommended initial dosage is 20mg daily.
• For bulimia nervosa; The recommended dosage is 60mg daily
• For obsessive-compulsive disorder; The recommended dosage is 20 to 60mg daily

Daily doses should not exceed 80mg and it is usually recommended that you take Prozac in the morning. It can be taken with or without food.

Do not take a double dose if you miss a dose. Simply continue with your next scheduled dose.

The benefits of Prozac are unlikely to be felt for at least 4 weeks. However, it is important that you continue taking Prozac even though you cannot see any initial signs that your symptoms are improving.

Do not stop taking Prozac once you feel better. Prozac therapy is designed in part to help prevent further depressive episodes occurring. Your doctor will determine the period of treatment time with this in mind. Your doctor should monitor you regularly throughout the whole of your treatment.

Side Effects

In keeping with all medications, you may experience some side effects while taking Prozac. You should discuss any side effects with your doctor. Side effects from taking Prozac may include:

• Skin rash
• Allergic reactions
• Serotonin syndrome which has a number of symptoms including fever, joint stiffness, muscle shaking, dizziness when getting up, excessive perspiration, irregular heartbeat, confusion, irritability or extreme agitation
• Sensitivity to daylight
• Weight loss
• Gastrointestinal disorders such as diarrhoea, nausea or vomiting
• Nervous system complaints including headache, sleep disorders, dizziness, anorexia, fatigue, feelings of euphoria, and transitory abnormal movements such as muscle spasms or trembling. You may also experience hallucinations, manic reactions, confusion, agitation, anxiety and associated symptoms (e.g. nervousness), difficulty concentrating and thinking and panic attacks
• Respiratory complaints including pharyngitis and difficulty breathing
• Urogenital disorders including sexual dysfunction, prolonged and/or painful erection and milk secretion
• Hair loss
• Vision abnormalities

Effects on Stopping Treatment

When you stop taking Prozac you may experience dizziness, tingling sensations, headaches, anxiety and nausea. Generally if you do experience any of these effects, they will be moderate and temporary but if you have any concerns at all you should raise them with your doctor.

Warnings

Do not take Prozac if you have ever had any type of allergic reaction to fluoxetine or any other ingredients in the capsules.

Prozac may interfere with other anti-depressants, particularly MAO inhibitors and other SSRIs. Do not combine Prozac with any other anti-depressants unless you are doing so under the guidance of your doctor.

With regard to MAO inhibitors, you must leave a period of two weeks between finishing treatment with an irreversible MAO inhibitor and starting Prozac treatment. However, you can start Prozac the day after ending treatment with a reversible MAO inhibitor. If you have been taking Prozac but need to change to a MAO inhibitor, wait at least five weeks between stopping Prozac and starting any MAOI.

As with all medications you should fully advise you doctor of any medications (both on prescription and over the counter) that you are currently taking or have taken before using Prozac because these medications may interact with Prozac. Dosage adjustments or even discontinuing Prozac therapy might be required. This warning is particularly relevant with regard to:

• Drugs that affect blood coagulation
• Preparations containing St John's Wort
• Phenytonin and carbamazepine (used for the treatment of epilepsy)
• Tramadol
• Triptans (used for the treatment of migraine).
• Lithium or tryptophan
• Flecainide and encainide (for the treatment of heart arrhythmias)
• Tricyclic antidepressants

 You should exercise caution when taking Prozac if:

• If you suffer from or have suffered in the past from convulsions
• If you suffer from or have suffered in the past from some type of haemorrhage
• If you have ever received electroconvulsive therapy (ECT)
• If you suffer from or have suffered diabetes, heart disease, liver or kidney disease or mania /hypomania

You should be aware that suicidal tendencies (including suicide attempts) that can be experienced during depression may still occur until a significant recovery has taken place.

Pregnancy and Breast Feeding

Do not take Prozac while you are pregnant unless your doctor believes that the expected therapeutic benefits of Prozac treatment justify its use. This is especially true during the final stage of pregnancy and just before you give birth.

Do not take Prozac if you are breast feeding because Prozac is excreted into breast milk.

Driving and Operating Machinery with Prozac

Prozac may cause drowsiness, lower your reflexes and ability to react. It is therefore advisable not to drive, operate machinery or engage in other tasks that require you to pay special attention, until you know how you react to your Prozac treatment.

Alcohol

You should avoid alcohol while taking Prozac.

Above all, it is vitally important that Prozac is only taken under the supervision of your doctor and your progress throughout your treatment period is regularly monitored.