Nearly 15 million American adults will have at least one major depressive episode in their lives. With depression being the leading cause of work disability in younger adults, this illness has a tremendous impact on productivity for all industries. Approved for use in the United States in 1987, Prozac quickly became one of the most prescribed drugs for depression. Also known by its scientific name, fluoxetine, Prozac increases the level of serotonin in the body. An increase in serotonin levels causes mood stabilization. While Prozac is most commonly used for depression, it has also been approved for anxiety, obsessive-compulsive disorder, and premenstrual syndrome. Other names for Prozac are Fontex, Seromex, Seronil, Sarafem, and Fluctin.

It’s Not All Rosy
Though it’s safe and effective for most patients, Prozac does have potentially harmful side effects. The most widely reported of these are:

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  Neurological: Headache, dizziness, tremor, seizure, restlessness, fatigue, abnormal vision, and decreased libido.

  
  


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  Gastrointestinal: Nausea, vomiting, diarrhea, dry mouth, heartburn, upset stomach, and constipation.

  
  


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  Psychological: Insomnia, anxiety, and agitation.

  
  


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  Cardiovascular: Heart rhythm abnormalities and high blood pressure.

  
  


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  General: Flu-like symptoms, fever, excessive sweating, yawning, weight loss, and rash.

  
  

Because it’s metabolized by the liver and excreted through the kidneys, people who are taking Prozac and have liver or kidney disease must be observed to be sure there’s no abnormal buildup of the drug. Many drugs that are metabolized in a similar pathway, such as some psychiatric or heart medications, may have adverse effects when used with Prozac.

Rare but Possibly Deadly
Serotonin syndrome is a rare but potentially fatal adverse reaction characterized by mental confusion, fever, rapid heart rate, and muscle rigidity. This uncommon event occurs mainly due to interactions with a small number of psychiatric medications.

An Antidepressant That Causes Suicide?
Several years ago, because of anecdotal accounts of suicides in patients using Prozac, especially adolescents, the manufacturer issued a warning in its prescribing materials about the potential increased risk of suicide. The increased risk of suicide is currently being evaluated, and more studies are needed to determine the validity of this claim.

Effective Alternatives
Alternative treatments for depression are available. The best-studied natural treatments for depression are St. John’s wort (hypericum), S-adenosyl methionine (SAMe), and omega-3 fatty acids. Although the mechanism of action is not completely understood, these alternative medications are effective in many patients who have mild to moderate depression. Psychotherapy remains the most effective associated treatment for depression. However, there are other therapeutic methods that have helped reduce depressive symptoms, such as acupuncture, light therapy (for seasonal mood disorders), massage, aromatherapy, routine exercise, music therapy, nutrition (reduction of sugars, caffeine, and alcohol), and improvement of sleeping disorders.

Don’t Take It Lightly
Though it’s safe for most users, patients should weigh the potential health risks before taking Prozac. Before discontinuing Prozac or any other medication for depression, contact your health-care provider. Consider natural medications and other forms of treatment for depression either alone or in conjunction with prescribed medications, but do not combine herbal and prescription treatments without first discussing this with your doctor, since harmful interactions may occur. Most important, if your current treatment regimen for depression is not fully effective, contact your health-care provider immediately to discuss another treatment strategy. Your well-being is too important to take lightly.

—Marie President, M.D.