Prozac Addiction and Treatment
Prozac Addiction and Treatment
The original “happy pill” was fluoxetine, more commonly known as Prozac. This medication, approved for use in 1987, was the first drug of its kind to be prescribed and marketed on a large scale. The use of this medication is very common, especially for the treatment of depression, but it is not without its risks. This article will explain what Prozac is, what it is used for, what the risks of long-term fluoxetine use are, and how its use can be ended safely with treatment in a drug rehab facility.
What is Prozac and How is it Used?
Prozac is an anti-depressant medication. Also known by its generic name, fluoxetine, this drug is currently approved by the United States Food and Drug Administration (FDA) for the treatment of major depressive disorder (MDD), obsessive-compulsive disorder (OCD), bulimia nervosa, panic disorder, and also for pre-menstrual dysphoric disorder (PMDD), which is more severe than premenstrual syndrome (PMS).1 It is also prescribed “off-label” (meaning the FDA does not approve these uses) for anxiety, obesity, binge-eating disorder, premature ejaculation,2 body dysmorphic disorder, dysthymia, and post-traumatic stress disorder (PTSD).1 Fluoxetine is typically used to treat depression in adults but may be used in smaller doses to treat depression in children and adolescents over the age of 10.
Prozac helps to elevate mood and energy levels, improve sleep, and increase appetite. It also works to decrease anxiety and fear and to suppress unwanted thoughts. Fluoxetine can help to decrease the number of panic attacks that a person has and to lessen their severity.
How Common is Prozac?
Prozac and its generic equivalent, fluoxetine, are commonly prescribed by physicians. In 2017, 21,913,276 prescriptions for fluoxetine were written in the United States, making it the 31st most commonly prescribed drug in the country for that year. Prescriptions for fluoxetine peaked in 2015 when it was the 20th most prescribed drug.3
Is Prozac a Controlled Substance?
Controlled substances are defined as drugs that have a high potential for abuse and addiction, according to the Controlled Substances Act of 1970. Drugs that fit the definition of controlled substances are listed on controlled substance schedules according to the level of risk of abuse and addiction, as determined by the United States Department of Justice’s Drug Enforcement Agency (DEA). The DEA does not consider fluoxetine to have a high risk of abuse or addiction, so it is not listed on the controlled substances schedules.
What are SSRIs?
Fluoxetine belongs to a class of drugs known as selective serotonin reuptake inhibitors or SSRIs. They work by blocking the reabsorption of serotonin, a neurotransmitter, by neurons in the brain. This leaves more serotonin available to transmit signals between brain neurons, alleviating depression. SSRIs are the most commonly prescribed antidepressants in the United States. They are considered safe and have fewer side effects than other antidepressants.4
While SSRIs, including Prozac, are considered safe in most instances, there are some circumstances in which caution is warranted regarding fluoxetine. These circumstances are:
When taking blood thinners, such as warfarin, or non-steroidal anti-inflammatory drugs (NSAIDS). Fluoxetine also acts as a blood thinner, so combining it with these drugs increases the risk of bleeding.
When the person is under the age of 25, some adolescents and young adults have developed suicidal tendencies after taking SSRI medications.
When taking other anti-depressant medications or supplements to improve mood, as these can decrease the effectiveness of Prozac or can cause dangerous drug interactions.
When pregnant, SSRIs may harm the baby.
Prozac Misuse and Abuse
Even though fluoxetine is not on the controlled substances schedules, people do abuse it at times. Those people who do abuse it usually have a history of substance abuse and usually abuse it in combination with other drugs. A 2014 literature review on the abuse and misuse of antidepressants found a small number of cases of fluoxetine abuse by people who had histories of abusing multiple drugs, as well as histories of mental illness. These people abused fluoxetine by taking it in large quantities or taking it for reasons other than depression, such as using it as an appetite suppressant. There were also a couple of cases of people who used fluoxetine intravenously, or who opened up the drug capsules and sucked in the powder.5
Street names for Prozac include:
Happy Pills
Wonder Drug
Bottled Smilies
Miracle Drug
The misuse or abuse of fluoxetine and other anti-depressants can lead to dangerous situations if antidepressants are taken at high doses or if they are combined with other drugs. Statistics from the Centers for Disease Control from 1999 to 2017 show a steady increase in overdose deaths involving antidepressants, from 1,749 in 1999 to 5,269 in 2017. The following chart separately tracks deaths caused by antidepressant overdose without any other drug involvement (Series 1), deaths caused by antidepressants combined with opioids (Series 2), and deaths caused by antidepressants combined with other synthetic narcotics (Series 3):6
As this chart shows, the number of overdose deaths due to antidepressants combined with opioids or other synthetic narcotics increased at a much faster rate than the number of overdose deaths due to antidepressants alone. Note the sharp increase in deaths involving synthetic narcotics from 2014 to 2017. These increases are consistent with the national increases in overdose deaths due to opioids and synthetic narcotic involvement overall.
Side Effects of Prozac
The common side effects of fluoxetine are as follows:
Sleepiness or insomnia
Dry mouth
Headache
Nausea
Diarrhea
Restlessness
Fatigue
Sweating
Sexual side effects
Rare side effects include:
Sweating
Angle-closure glaucoma
Teeth grinding
QT prolongation and ventricular arrhythmia
Seizures
One severe side effect that can occur with fluoxetine use is serotonin syndrome. This condition occurs when too much serotonin accumulates in the body. Symptoms of serotonin syndrome include:
Shivering
Goosebumps
Headache
Confusion
Dilated pupils
Heavy sweating
Agitation/restlessness
Rapid heart rate
High blood pressure
Muscle twitching or loss of coordination
If serotonin syndrome becomes severe, the following symptoms may occur:
High fever
Irregular heartbeat
Seizures
Unconsciousness
Serotonin syndrome can be fatal if it is not treated promptly.7 Medical professionals must treat this condition.
Long Term Effects of Prozac
If taken as prescribed by a physician, Prozac is generally safe to use for the conditions mentioned above. Fluoxetine and other antidepressants were originally designed to be taken for a short term. However, many physicians and psychiatrists have continued to prescribe these medications for people who have taken them for years. A data analysis completed by The New York Times, using data from the National Health and Nutrition Examination Survey, found that almost 7 percent of adults in the United States have taken prescription antidepressants for at least 5 years. White women over the age of 45 made up 58 percent of this group.8
Stopping is Difficult
It has long been assumed that the use of Prozac, whether short- or long-term, is safe. However, patients who have attempted to discontinue the use of fluoxetine after using it for a long time have often found it extremely difficult to stop, even when the drug is discontinued gradually under the supervision of a physician. Not everyone who stops taking fluoxetine experiences withdrawal symptoms, but many people do.
A study of long-time antidepressant users found that, out of 180 patients, more than 130 reported withdrawal symptoms, and almost half of the study participants reported feeling addicted to antidepressants.8
New Zealand Study
Only in recent years have researchers begun to examine the effects of long-term use of fluoxetine as well as its withdrawal symptoms. A study conducted in New Zealand examined 250 patients who had been taking fluoxetine for two or more years. Half the participants were given gradually tapered doses of fluoxetine, and the other half were given a consistent amount of the drug. The researchers followed the participants over eighteen months. The study found that those taking the tapered doses experienced withdrawal symptoms. In some cases, these were so severe that patients had to begin taking the drug again, even when the drug was tapered gradually over months.8
Withdrawal Symptoms of Prozac
While fluoxetine is not considered to be an addictive drug, the medication does make changes to the chemistry of the brain that cause people who take it to become dependent on it. Long-term drug dependence is not the ideal situation for most people and many who take antidepressants like fluoxetine attempt to decrease their dosages on their own or stop taking their medication entirely. If fluoxetine is stopped abruptly, or if the dose is decreased too rapidly, however, the following symptoms of withdrawal may occur:
Irritability
Nightmares
Nausea and vomiting
Headaches
Dizziness
Tingling or prickliness of the skin1
Discontinuation Syndrome
The symptoms of withdrawal that occur when the use of an antidepressant is ended are referred to by medical professionals as discontinuation syndrome. These symptoms for other antidepressants are similar to the withdrawal symptoms for Prozac listed above but may occur in varying degrees of severity. Some medications cause more severe symptoms of discontinuation syndrome than others, primarily due to how quickly the drugs remove themselves from the body.
This removal period is often compared in terms of the drug’s “half-life,” the time it takes for the concentration of a drug in the bloodstream to be reduced by one-half. On average, symptoms of discontinuation syndrome last for 1 to 2 weeks but may be present for up to a year,9 depending on the medication and on how long the person has taken that medication.
20% of Patients Will Develop Discontinuation Syndrome
It is estimated that about 20% of patients who have taken an antidepressant for a month or more develop discontinuation syndrome, or antidepressant withdrawal, after stopping use of the medication.9 Interestingly, fluoxetine has the longest half-life of all the SSRI medications, so it is associated with the lowest risk of discontinuation syndrome. In fact, fluoxetine is often used as a treatment for discontinuation syndrome when a person is ending the use of another SSRI medication. This is concerning when viewed in light of the research results mentioned above, which indicate that fluoxetine carries the same risk of discontinuation syndrome. Since fluoxetine is often used to treat long-term mental health conditions such as OCD, discontinuation syndrome may be more severe for these patients than for patients who use Prozac in the short term to manage withdrawal symptoms. Still, caution should be taken when discontinuing fluoxetine, and ending the use of any antidepressant should be done under the supervision of a physician.
Treatment for Prozac Dependence
The types of treatment used to end dependence on fluoxetine depend on the circumstances surrounding how the medication is used. For people who abuse Prozac or take it in an attempt to self-medicate, treatment should focus on any other substances that are abused along with fluoxetine and on the conditions that people are attempting to treat. For example, a person taking fluoxetine as an appetite suppressant should receive treatment for the eating disorder associated with this use of the medication. People who use fluoxetine and alcohol or fluoxetine and opioids together should receive treatment for abuse of those respective substances.
As stated previously, people who want to end the use of medically prescribed fluoxetine should do so under the supervision of their physicians. Stopping Prozac “cold turkey” is not recommended due to the withdrawal symptoms listed above. Prozac should be tapered gradually until a person can function without the drug with no withdrawal symptoms. The longer a person has taken Prozac, the longer it will take to taper off the medication. In some cases, this may take months or even over a year.
Ongoing Support while Quitting Prozac
It is important to remember that as Prozac is tapered, the symptoms that the medication was used to treat may return. A person who used fluoxetine for major depressive disorder may experience symptoms of depression again. People with obsessive-compulsive disorder may experience more intrusive thoughts. These symptoms should be monitored and managed if they occur. In some cases, a person may need to discuss the pros and cons of ending fluoxetine use with their physician, as ending the use of the drug may be worse than staying on it.
People who want to end Prozac use should also continue with other treatments that they have received for their respective conditions. Therapy, counseling, educational services, and social support should all be in place before a person begins to end Prozac use, just in case the symptoms of the condition reappear. These services will help the person manage those symptoms as they taper the drug. If a person has not required services for a while due to the condition being stable, they should make sure to re-establish contact with service providers before tapering Prozac. Periodic monitoring by a therapist or counselor may help the patient and physician to manage symptoms and to determine how stable the patient’s condition is overall as the drug is tapered.
Find Recovery from Addiction
On the whole, Prozac is a safe drug to use for the treatment of mental health conditions for which the FDA has approved it and on a short-term basis. Using Prozac to self-medicate can be dangerous, so Prozac should always be used under the supervision of a physician. Long-term use of Prozac can cause drug dependence, so ending the use of Prozac should always be done under the supervision of a physician. People who want to end Prozac use should not try to quit on their own but should seek help.
Resources
- https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Types-of-Medication/Fluoxetine-(Prozac).
- https://www.medicalnewstoday.com/articles/263773.php#uses.
- www.clincalc.com/DrugStats/Drugs/FluoxetineHydrochloride.
- https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825.
- www.ncbi.nlm.nih.gov/pmc/articles/PMC4140701/.
- www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates.
- www.mayoclinic.org/diseases-conditions/serotonin-syndrome/symptoms-causes/syc-20354758.
- www.nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.html.
- www.ncbi.nlm.nih.gov/pmc/articles/PMC5449237/.
