Prozac (generic name: fluoxetine) is a medication used to treat a variety of mental health conditions, most commonly depression. Almost 22 million prescriptions were dispensed for Prozac in 2017, ranking it number31 on the list of most frequently prescribed medications.1 That’s down from a high of more than 28 million in 2015, when Prozac was the twentieth most frequently prescribed drug.1 Worldwide, approximately 54 million take the medication.2 Prozac is also sold under the names Sarafem and Selfemra.1
According to current research, Prozac has not been cited as having a potential for abuse, tolerance, or physical dependence. However, there are some cases to the contrary (see section “Is Prozac Abused and Misused?”).3 Currently, there are some studies that support withdrawal symptoms or drug-seeking behavior that are related to Prozac.
The National Institutes of Health does caution that prescribing doctors should screen their patients if they have a drug abuse history, or to see if they misused or abused Prozac.3 Possible signs would be the development of tolerance, increasing the doses, as well as drug-seeking behavior.
Some published case studies indicate Prozac has been misused and abused in the following ways:
A person with anorexia nervosa misused high doses of fluoxetine for weight loss and to suppress appetite.4
A person with a drug abuse history misused fluoxetine by breaking open the tablets and taking the contents orally for stimulant effects.4
Prozac has the designation, or EPC (Established Pharmacologic Class) of an SSRI (Selective Serotonin Re-uptake Inhibitor).3
The U.S. Drug Enforcement Agency (DEA) Schedule of Drugs lists substances that have a potential for abuse and dependence. Prozac is not considered a medication that has the potential for abuse and dependence by the DEA. Therefore, it is not on the DEA Schedule of Drugs.
Research indicates that Prozac is generally safe when it is taken as directed. One research study based on a group of 9,087 people over 87 different studies confirmed that fluoxetine:
The street names for Prozac include:
Major Depressive Disorder
Obsessive Compulsive Disorder (OCD)
Binge-eating and vomiting behaviors associated with Bulimia Nervosa
Panic Disorder, with or without agoraphobia
Fluoxetine, sold under the brand name Sarafem, is used to treat the symptoms of PMDD (Premenstrual Dysphoric Disorder), including bloating, mood swings, irritability and breast tenderness.6
According to the DEA, those who are passing medications through their bodies and flushing unused drugs down the toilet are major public health issues. Antidepressants in the water can be ingested by fish and cause side effects like lower sex drives, which affects their reproductive habits and number of offspring.2
It is estimated that between 1988 and 2009, approximately more than 12 million fluoxetine capsules were dispensed around the world.2 Humans excrete about ten percent of the fluoxetine they consume unchanged (in its original state) which when flushed, enters the water system.2 Also, many dispose of unused medication by flushing it down the toilet, which also enters our waterways. Therefore, it’s important to dispose of Prozac, and any other medications, through a local medication collection program. A pharmacist may have a medication collection program to dispose of medications with minimal impact on the environment.
A short term effect of antidepressants such as Prozac may be a worsening of depression and the development of suicide during the first treatment phases. Antidepressants increase the risks of suicidal ideation (thinking about harming or killing oneself or planning or trying to do so) and suicide in children and teens, as well as young adults in the age group of 18-24 years with depression and other psychiatric illnesses.3 The increased risk of suicide with antidepressants is not seen in adults beyond 24 years old.3 There was a decreased risk of suicide with antidepressants for adults ages 65 years and older.3
For those who are taking antidepressants and depression worsens, suicidal thoughts occur, or there are any unusual changes in behavior, especially during the first several months, or during dosage changes, it is advised to consult a physician right away. Other side effects of antidepressants such as Prozac include:3
Hypomania (mind form of mania)
Mania (abnormally elevated or irritable mood, arousal and/or energy levels)
Acting without thinking
It is strongly advised that a physician be consulted if any of the above symptoms occur.
Depression is typically managed with the long-term use of medications such as Prozac. This may result in long-term side effects when individuals have been using an SSRI drug for years. One study found that adverse side effects developed after people had used Prozac for six to ten years. Those side effects included:7
Serotonin syndrome is a potentially fatal condition that has been reported with the use of antidepressant drugs, including Prozac.3 This condition develops from taking medications that affect serotonin levels. Serotonin is a chemical in the brain that regulates appetite, mood, and sleep habits, as well as a sense of wellbeing.
Serotonin syndrome can develop due to:3
Prescription medication use, particularly SSRIs and SNRIs (serotonin-norepinephrine reuptake inhibitors)
Unexpected interactions between other prescription drugs or recreational drugs
Using SSRIs with other drugs or supplements that affect serotonin levels, such as triptans, fentanyl, lithium, buspirone, tryptophan, St John’s Wort, MAOIs and amphetamines.
A mind to dangerous change in mental status
Muscle twitches or spasms
Lack of coordination
At the onset of any of these symptoms, a physician’s assistance should be sought immediately or seek emergency medical care.
Some many drugs and substances can contribute to the development of serotonin syndrome. The treating doctor must be aware of what other medicines and supplements the patient is taking before they begin any new medication.
Heart rhythm disorder
Cardiac conduction problems
The best option to stop using Prozac is to consult a doctor or a treatment center. Medical and mental health professionals are needed for individuals to stop taking Prozac safely.
The steps for stopping Prozac could include:
There is research that points to a withdrawal syndrome developing when individuals stop taking Prozac abruptly.9 It is important to consult a doctor to safely stop taking Prozac. It is not recommended to stop or taper off the drug without a doctor’s help. Doing so can result in withdrawal symptoms in as early as two days or as late as two weeks.9
Common withdrawal symptoms that individuals experienced in the research study were:9
Abnormal muscle tone
Rebound of the condition Prozac was initially prescribed for (i.e. When Prozac was prescribed for depression and then stopped, depression worsens.)
The first step for many in stopping the use of medications is undergoing medical detoxification. A medically supervised detox helps clear the body of Prozac and any other substances in a safe manner.
Detoxification programs have trained healthcare professionals on hand to help the individual taper down from substances. They do so by providing medications to reduce or eliminate withdrawal effects. Detox can be done on an inpatient or an outpatient basis.
An inpatient detox in a residential facility can be more effective than doing it on an outpatient basis because withdrawal symptoms can be treated as they happen. Also, inpatient detox is a safer setting since clients are monitored 24/7 for any health problems or medical complications.
Detoxification is not a standalone treatment. A detox simply readies the mind and body for further therapies. One then has two treatment options: inpatient or outpatient rehab. The better option depends on:
How long they have been on Prozac
The nature of the psychiatric condition Prozac was prescribed for
How long they have had the psychiatric condition Prozac was prescribed for
The severity of their psychiatric condition
The seriousness of any Prozac misuse or abuse
The person's living situation (stable or unstable)
If the person is a danger to him/herself or others
Misuse and abuse of prescription drugs such as Prozac are treatable. Also, any psychiatric conditions an individual has will benefit from treatment. Psychotherapies, also called talk therapies, help them successfully recover. Talk therapies, unlike drugs, produce no side effects.
Evidence-based treatments that work well in drug misuse and mental health conditions include:
CBT is a practical approach that teaches strategies and skills for dealing with problem behaviors and mental health problems. CBT can help participants by teaching them how to cope with depression, anxiety, eating disorders, and other psychiatric problems. For example, CBT can be used to treat depression by helping clients identify and change distorted thoughts that can result in depressed moods. Practical hands-on strategies are developed to handle distorted thoughts as they occur and to replace them with positive ones effectively.
When someone has a mood or eating disorder, sometimes the roots of these conditions can be from memories stored in the brain’s neural networks. For many individuals, the problems reside in unprocessed memories that sabotage their present lives. Examples of these types of memories that can have adverse effects are trauma-related events such as natural disasters, assault, domestic violence, and war combat.
EMDR helps identify these memories that are causing problems, such as depression or post-traumatic stress disorder. EMDR is used to change the ways a person processes negative emotions, physical sensations, and thoughts that are related to those memories.
EMDR directly treats negative feelings and beliefs, such as:
Not feeling "good enough" (low self-esteem)
Not feeling in control (helplessness)
Feeling fearful frequently
Feeling sad or upset at past events
When emotions and beliefs such as these dominate people’s lives, they sometimes blame themselves. Because unprocessed memories are at the root of these issues, they must be reprocessed for real progress to occur.
In EMDR, clients discuss the events they experienced. As they talk, they describe the feelings, physical sensations, and beliefs they have and are experiencing. Simultaneously, clients move their eyes back and forth in rhythmic and sweeping eye movements. Alternatively, they may rhythmically tap their fingers. This dual attention method helps clients feel more at ease as they discuss adverse events, which reprocesses the memories and casts off the negativity associated with them.
DBT is an effective way to treat depression and other psychiatric conditions. First, a strong client-therapist relationship is developed. The client then commits to changing and then identifies the thoughts, emotions, and behaviors that are causing problems. The therapist guides the client by discussing different ways to improve the designated areas. For each area of change, healthy coping skills and practical strategies are learned. New goals for renewing overall emotional and physical health may also be included.
On either an inpatient or outpatient basis, while a person is in treatment, medications can be prescribed that will help relieve withdrawal symptoms. Other drugs can also be prescribed that replaces Prozac and treats the psychiatric condition for which Prozac was prescribed in the first place.
Complementary therapies such as deep breathing, exercising, meditation, and yoga can be used along with conventional medicine to help relieve symptoms of depression and anxiety.
Alternative therapies such as music, art, and dance therapy can help encourage stress relief, express repressed feelings, improve moods, and channel positive emotions.
Once formal treatment is completed, the individual needs to have an aftercare plan in place to ensure there is no relapse. Continued counseling and medications are typically part of this. An aftercare plan also takes into account monitoring the person’s psychiatric condition.
Living arrangements are also a consideration in an aftercare plan. If the individual is exiting from residential treatment, either an existing, stable home is needed, or alternative living arrangements need to be in place.
Some benefits of aftercare may include:
Relapse prevention education
Substance abuse education
Education on risks that can jeopardize recovery
Relationship and social skills classes
Training on how to cope with family issues
Education on emotional management techniques
How to manage substance abuse triggers
Group meetings where advice from other people helps manage daily life
Job and vocational skills development
Drug and alcohol testing
Peer group meetings for understanding and discussion of any problem areas
If you or a loved one are struggling with Prozac abuse or addiction, it’s essential to seek help right away. The side effects and dangers of Prozac misuse and abuse can happen quickly, so talk with your doctor or contact a treatment center.
A person who wants to begin recovery should seek professional help that treats the drug abuse problem, as well as the mental health conditions that first brought about Prozac abuse. Since these issues are inter-related as well as complex, treatment by mental health professionals is essential. Reach out today and get started on a better and healthier life without Prozac abuse and addiction. Recovery is possible, so take the first step towards it today.