How afraid of Fluoxetine (and its "pretty gnarly" side-effects) should I be?

June 30, 2009 7:40 AM

CrazyMedsFilter: How afraid of Fluoxetine (and its "pretty gnarly" side-effects) should I be?

I'm sure you've all been there.

The free clinic psychiatrist, a man who has known you for all of about 11 minutes, has you fill out an insultingly childish questionnaire. ("Have you felt sad in the last few weeks?") You mark 4 out of the 6 questions as "yes," win an instant (yet very vague) diagnosis of depression, and receive a prescription for a month's worth of SSRIs. You leave the clinic feeling confused and offended, wondering if your mental health problems are as trivial as this doctors visit has made them seem. And you're nervous about taking a brain-altering medication that is handed out as liberally as free pens.

This has happened to me twice.

The first time was when I was 19. I was young, struggling through my first bout of depression, terrified by the sense of catastrophic dread that seemed to come out of nowhere every morning, and seriously considering killing myself. I was willing to do anything to feel better. So I took the doctor's word, filled my prescription, and went on Effexor for a few months.

It was hellish. Not only did the pills do nothing for my dark mood, but when I tried to ween myself off of them, I went through the insane helltrip of SSRI discontinuation syndrom that the drug is now famous for.

So now, 7 years later, I'm back in that very dark place of self-loathing, panic, and dread. My free clinic counselor urged me to see a psychiatrist. Another questionnaire, another prescription--this time for Fluoxetine. After hearing my Effexor horror story, the doctor assured me that, due to its long half life, Fluoextine had very mild discontinuation effects.

I'm willing to do anything to get back to my functional self. But once bitten, twice shy.

A quick search on CrazyMeds.us turned up a mention of "pretty gnarly" side-effects, including weight gain and loss of libido. Which, to a depressed single guy in his mid-twenties already struggling with dating, sounds like suicide-ville.

So i'm turning to Filterites for a second opinion. Anyone out there try Fluoxetine? Are the potential results worth the potential side effects? Should I treat the prescription as a last resort and experiment first with an altered diet and meditation? Am I being too paranoid after my Effexor nightmare?

I would love to hear any anecdotes you might have pertaining to this drug, be they stories of horror or success.

posted by anonymous to health & fitness (12 comments total)

Two things:

First, I'm going to answer your question directly based on both my own personal experience and that of someone very close to me. In our cases, there were no- to very-mild side-effects. I know that the plural of anecdote is data, but really, I've never heard of anyone having really nasty side-effects beyond "my brain gets these weird shocks" and sightly lowered sex drive.

Okay, so there's that. Now, the second part. I don't know what your particular situation is, but you really need to seek out regular counseling. You're right, some clinic worker isn't in the best position to diagnose you. All they have is a survey based on the criteria in the DSM-IVr, and your own internal knowledge. You need an advocate and someone who can observe you regularly, as well as help you cope with the changes that the drugs will cause. The drugs are only one half of a treatment program, and you need to get the other half.

Lots of universities have low- to no-cost counseling programs run my their mental health departments. There are also commonly state, county, or city-run programs for low-income or uninsured/underinsured people. Barring that, lots of doctors will work with you on cost. Barring that, what is your mental health worth to you? Hourly costs may not be as high as you fear.
posted by TheNewWazoo at 7:58 AM on June 30, 2009 [1 favorite]

Fluoxtine is prozac, right? I took prozac years ago, before there was a generic version on the market. I don't recall it being particularly effective, but I don't recall side effects other than a headache the first week or so. I had no problems when I stopped taking it. I had a friend who responded well to it, once the generic came out and she switched, she said the generic wasn't as effective. So, if you got a month's worth of samples for the name brand and switch to the generic, you might notice a difference.
posted by necessitas at 8:10 AM on June 30, 2009

Okay. These are my personal experiences, YMMV.

The first SSRI I ever took was Lexapro. I was very anxious and very depressed, and it made me borderline insane and unable to have an orgasm. My current doctor says this is a pretty normal experience. Lexapro works well for people who are mildly depressed or anxious. That experience made me terrified of ever taking an SSRI.

I went on Wellbutrin and that really helped the depression, not so much the anxiety, so my doctor at that time switched me to Prozac. Knowing I'd had a horrible reaction to the Lexapro, and that I was very hesitant to try another SSRI, he prescribed the drug for me in liquid form, and I'd ramp up extremely slowly. I had a headache for a couple of days, and that was pretty much it.

Honestly, I don't really remember much about taking Prozac, other than it made me exhausted (I have atypical depression and I was also taking Ativan, so that probably didn't help matters). I was basically a zombie. I was pretty bad at taking my medication and I never really went through any noticeable withdrawal effects, even when I decided to stop taking it out of the blue. I think Prozac has a longer half-life than most other anti-depressants, so that makes it easier to discontinue. So yeah, my Prozac experience wasn't terrible, but it wasn't the right drug for me.

I took Effexor for nearly a year. Coming off it was the worst experience I've ever had with an antidepressant. I was sick for two months. Do not let your experience with Effexor influence your opinion of antidepressants. Prozac was significantly easier to deal with. If you can afford to pay for Effexor out-of-pocket, you can probably afford liquid Prozac. Ask your doctor about it. I think being able to start out slow helped my anxiety about taking a new SSRI a great deal. Maybe it made getting on a bit easier -- I have no way of knowing that.

If you have any questions, drop me some mail.
posted by giraffe at 8:14 AM on June 30, 2009

Comparing Fluoxetine (Prozac) and Effexor is a bit pointless, because they're completely different drugs with completely different biochemical mechanisms.

It's like saying "I'm afraid to take aspirin for my sore shoulder, because when I had a steroid injection there, it made my face puffy--will aspirin make my face puffy?" Both medications address the same issue--inflammation--but in different ways, and with different side effects.

Now, I am a great advocate for Effexor, because it has saved my life. But, yeah, the getting off of it is tough--I am at the end of a multi-month tapering-off, and haven't had any negative symptoms, but I am lucky enough to be able to have found (and to afford) an amazing psychopharmacologist.

Fluoxetine, on the other hand, is much easier to get on and get off of. Just ignore

Here's the thing about anti-depressants: they're medicine. You take them because you have an otherwise debilitating medical problem that endangers your life and health. Like almost all medicines, they have side effects.

So, as with all medical decisions, you weigh whether the side effects or the condition you're experiencing are worse.

Should I treat the prescription as a last resort and experiment first with an altered diet and meditation?

If you're eating unhealthily, you should probably change that anyway, even if you're going to take the fluoxetine. Meditation is great, but most people can't manage clinical depression through meditation or exercise or getting more sleep or eating better--that's why it's called "clinical" depression.

But maybe it's worth a try, depending on how urgent your symptoms are.

I'm sorry that you're having to deal with this without attentive support from a specialist (the free clinic psydoc may be highly competent, but there's no way anyone could do proper case management in that setting). Best of luck to you.
posted by Sidhedevil at 8:40 AM on June 30, 2009 [3 favorites]

I was on Fluoxetine for years and had very few issues. There is an adjustment period however. It took me a couple of months to acclimate to it. During that period, I had some gassiness and diarrhea, headaches, and a few periods where I was still depressed, but felt energized. The only sexual side effect I have experienced has been delayed ejaculation (very very infrequent). My sex drive in general increased. I t may promote weight gain, but I'm a "gentleman of stature" to start with so I wouldn't be able to confirm or deny that one

Here's the deal. If you need an antidepressant, it may take some experimentation to find the right one for you (Prozac was the third drug I tried). You may have a couple of bad experiences before you do. It is important that you do not self-medicate with this stuff. You need to be talking to a doctor regularly while you are finding out what works for you. Side effects can suck. Living life in a deep dark hole that you cannot pull yourself out of sucks much more.

When you do find something that works, get into counseling for a bit. If you have been living with severe depression for a while, you are going to have some mental house cleaning you'll want to do.

I hope it works out for you
posted by Lord Widebottom at 9:02 AM on June 30, 2009 [1 favorite]

I didn't notice many side-effects on fluoxetine, other than being VERY sleepy in the early evening when I took it in the morning. You might have to time your dose to avoid crashing when you need to be awake.

Otherwise, make sure you remember to take it every day for the first couple of months. I don't know the medical reason for this, but in my experience and from other anecdotal sources, missing an early dose can really throw you off. Not the end of the world, but it's not fun to feel totally miserable when you're supposed to be getting better.

And seconding TheNewWazoo-- Prozac won't do much without some sort of counselling, at least for the short-term.
posted by oinopaponton at 9:09 AM on June 30, 2009

I just wanted to second what sidhedevil said about effexor and prozac being to completely different drugs. Fluoxetine is a SSRI and effexor is a SNRI.

Also, what Lord Widebottom said, finding the right thing could take experimentation. Some meds aren't going to work, some will do the opposite (make people with depression but no suicidal tendencies feel suicidal), and some will work. What works for one person here isn't going to work for the next.

If fluoxetine doesn't help (and it could take 3-4 weeks to determine whether or not it's working), it could be the dose, could be the drug. I assume you were started out on it because it's a safe bet, it's general (as opposed to, say, lexapro, which is helpful for depression with anxiety or paxil, which is helpful for depression with social anxiety) and, since it's a free clinic, it's generic. If it makes you feel miserable, you might need something else or something in addition to fluoxetine. If you're having physical side effects like nausea or headaches, I'd advise you to wait them out because they should go away.

When it comes to managing mental health through medication, you really have to go into it with a you-are-your-own-lab-rat mentality. You know, "test subject reacts negatively when exposed to fluoxetine. Test subject responds well when exposed to [insert other anti depressant], how will test subject react when [additional med] is added to the [original med]"
posted by necessitas at 10:00 AM on June 30, 2009

I have been on Fluoxetine for about 4 years. I have very few side effects and they are mild. (increased bruxism, tendency to feel overwarm or sweaty thats about it, really)

I experienced no weight gain and no loss of libido or ability to orgasm.

also, I have weaned off both Fluoxetine and Effexor and while neither is easy, Fluox is no where as difficult as effexor!
posted by supermedusa at 10:25 AM on June 30, 2009

fluoxetine was the first anti-depressant I tried, and for me it helped a LOT. OTOH, fairly serious side-effects of the relationship-impairing variety, which is why I won't do it again. results were worth the side-effects initially, but not in the long run.

am now taking wellbutrin & celexa, the wellbutrin pretty much saved my life a couple of years ago IMHO. I would agree with necessitas that it helps to treat the medication experience as a scientific test of one, esp since the scientists are still a bit confused as to exactly how/why this stuff works.

Also, I highly, highly, highly recommend Feeling Good as an adjunct to both the medication and the counseling.
posted by epersonae at 10:37 AM on June 30, 2009

I hate to say it but "gnarly side effects" are based on the individual (IMHO). I don't think we can give an accurate account except our own experience. Individual results may vary. And a low cost/free clinic seems scary. I would go with more of a professional. Most do slide scale fees based on income. This guy and his survey chart based on DSM IV criteria that you could have done on the internet seems like a tool.
posted by dasheekeejones at 10:52 AM on June 30, 2009

Prozac and Effexor are way different.
You refer to Effexor as an SSRI in your post, but it's an SNRI.

Anecdotally: I have taken and have known multiple people who took Prozac and stopped. They had minimal side effects, mostly a kind of fuzzy feeling. I had no side effects, but Prozac did nothing for me while I was on it other than make me physically jittery (I have mild OCD, not depression). I've had two people very close to me take Effexor. They had a bad time on it (crazy mood swings, anger, etc.) and horrible withdrawal (severe headaches, even worse mood swings).
posted by ishotjr at 4:32 PM on June 30, 2009

I've taken several SSRIs and Effexor (not at the same time). Prozac was the easiest one to get off of. I felt kind of floaty for a few days (I stopped cold-turkey) but then was fine. Paxil and Zoloft were hellish to get off of. And I'm terrified of ever getting off of Effexor. Dreading it in fact.

So as you can see from the varied responses, side effects and withdrawl effects vary a lot by person.

Prozac may be the best thing that ever happened to you, so you might try it out.
posted by misanthropicsarah at 5:06 PM on June 30, 2009