Amy I jeopardizing my mental health treatment by missing my prozac sometimes?
January 12, 2011 7:31 AM   Subscribe

How big a problem is forgetting to take my antidepressant every few days?

I forgot to take my prozac again today. When I've got my act together, I keep some extras at work just in case I forget to take them while I'm still home, but I don't have my act together yet this month, and going home to take my meds isn't really possible.

I'm still pretty new to prozac; am I royally screwing myself each month when I take a few days to get myself organized with backups and failsafes, and inevitably miss my pill several days (usually nonconsecutively)? What are the consequences?
posted by ocherdraco to Health & Fitness (17 answers total)
IANAD, but Prozac has a long half-life, so missing a dose now and then is unlikely to have any noticeable effect. Still, I'm sure your doctor would prefer that you not miss any doses. Try asking for some samples or a prescription for 60 pills one month so you'll have a backup supply.
posted by shponglespore at 7:35 AM on January 12, 2011

Probably not a huge deal to miss the occasional anti-depressant pill, but it's not ideal either.

It's a good idea to take medication at the same time every day, as that will help you remember. Tie it to something else that you always do, such as eating breakfast.
posted by orange swan at 7:45 AM on January 12, 2011

Seconding orange swan - instead of it being "a thing you need to remember to do each day", make it "a thing that you always do every day right between brushing your teeth and showering", or "after you get out of bed and before you go to the bathroom to shower", or whatever works for you.
posted by EndsOfInvention at 7:59 AM on January 12, 2011 [1 favorite]

I was on prozac a while ago, and I noticed that if I was flakey with my dosages, I'd notice an emotional effect. If I missed it for about 3 days in a row, I was suddenly all kinds of weepy and doomful. Missing a single dose gave me a bit of twitchiness and a bit more low end in my emotional sine wave. Managing to take it daily at about the same time was the best, though -- it managed to clip to low end of that emotional signal while not interfering with the high end of happy.
posted by rmd1023 at 8:12 AM on January 12, 2011

I'm on Wellbutrin, and I've noticed that the difference between total compliance and occasional non-compliance isn't like a 20% drop in overall effectiveness - it's like a 90% drop. This will of course vary from person to person and drug to drug, but I do think that at least part of any antidepressant's benefit comes from the long-term "steady state" of having the stuff swirling around your bloodstream at more or less all times.
posted by julthumbscrew at 8:12 AM on January 12, 2011 [1 favorite]

SSRI withdrawal (which can sometimes happen with one missed pill) causes yucky stuff for some people, but as shponglespore says above, Prozac happens to have a long half-life compared to other SSRIs, so it's less of a big deal with Prozac than other SSRIs.

It sounds like you only get a month's supply at once and that's making it harder for you to keep up with things. If that's for insurance reasons, and having a bit extra would help, in the US most pharmacies sell generic Prozac (fluoxetine) at truly dirt-cheap prices - like $4 for a month's supply - so perhaps your doc can write you a scrip for some more. You could even keep an extra bottle at work. If you find this not to be true for your local pharmacy, there is also Costco's online pharmacy, which you do not have to be a Costco member to use.

Also, if you really have a tough time with the daily dosing, there is a once-a-week version of Prozac ("Prozac Weekly.")
posted by needs more cowbell at 8:12 AM on January 12, 2011

I've also read that the long half-life of Prozac makes it more forgiving of poor med compliance. My personal experience is with a different med (which I no longer take) but for what it's worth I found that rigid regularity (taking it as near as I could manage at the exact same time daily) very notably improved the efficacy of the medication and reduced my negative aspects and side effects. Keeping one of those compartment-for-each-day pill boxes next to my toothbrush etc. on the bathroom counter did a lot for me. Part of it is just getting used to it and learning to see taking the med as a necessity. Sure, you take your keys with you when you leave your place because you have to lock the door but you remember to put them in your pocket because it's just become an automatic function of leaving the house.

If you are seriously forgetful in general (i.e. you routinely walk out the door without having put your keys in your pocket) you might need to ask after more aggressive strategies to help you remember. I don't think you should let it slide on the half-life of the med, I think you should push for the potential benefits of firm regular compliance. Echoing others you can get extras and do things to make sure your away-from-home supplies don't get depleted, i.e. always write yourself a note reminding you to bring more from home when you need to take one.
posted by nanojath at 8:23 AM on January 12, 2011

Prozac is most definitely forgiving in this way. You can look at the wikipedia page for fluoxetine for details but the pertinent parts are here:
The blood level of norfluoxetine 4 weeks after the treatment discontinuation is about 80% of the level registered by the end of the first treatment week, and 7 weeks after the discontinuation norfluoxetine is still detectable in the blood.
Personally I found the full 20mg/daily dosage to be a bit high for my needs so I take it 4 times a week - MWFS - and don't notice any changes. Now, part of that, if you read the full article above, is that I have an established dose. If you're very new to it you have a little less latitude.

You might find it advantageous to get your doc to write your script for 90 day supplies rather than 30. For one, it's cheaper - fluoxitine has reached commodity levels and when I was paying out of pocket for a 90 day supply at Costco it was about $11. For another, you'll have more pills and can take a dozen to the office as a backup.

But really, once you make this a habit it'll happen less often and you can go from the almost-no-worrying you should be doing now to not at all. Maybe you can hang the bottle from your front doorknob so you won't forget it in the morning.
posted by phearlez at 8:40 AM on January 12, 2011

I used to have trouble remembering to take my SSNRI's every day because I took them after lunch and I'd get distracted in the afternoon at work. I finally set myself an Outlook Calendar event to go off daily at 1pm, and my phone is synced to go off too. Very helpful.

Now I take my pills at night, and I just make it part of my routine. Wash face, brush teeth, take pills. However sometimes I have trouble remembering when I'm out of town or on a weird schedule, so I have the alarm as a backup.
posted by radioamy at 8:55 AM on January 12, 2011

Response by poster: Thanks, folks. I'm generally pretty good about my meds, but the past couple weeks have been not so good, and I was a little worried.

I think I'm going to put a sign on my door that says "MEDS, LUNCH, PHONE, KEYS, WALLET?" since those are the things I forget most regularly.
posted by ocherdraco at 9:23 AM on January 12, 2011 [3 favorites]

What everyone says here is pretty accurate.

You aren't screwing yourself, nothing to freak out over, but if you are constantly skipping doses that's not optimal, and more importantly it's harder for your doctor to manage. Therapy will go better for you if you stick to a rigid schedule if only because it makes it easier to later adjust dosage/medication.
posted by TravellingDen at 9:28 AM on January 12, 2011

Counter to julthumbscrew, I've missed a dose here and there of my Wellbutrin regimen, and I hardly notice it, though I perhaps get a little more irritable. Just another data point. Perhaps the impact of non-compliance depends on how high your dosage is.

My doc told me that prozac has a long half-life, so occasional skipping shouldn't make much of a difference.
posted by emkelley at 10:57 AM on January 12, 2011

I also think an extra prescription/back-up bottle is a great idea, but you could also see if the doctor has some samples you could stash at work as a back-up if he or she isn't a big fan of the extra Rx.
posted by Eyebrows McGee at 11:07 AM on January 12, 2011

I took Prozac weekly for about a year quite awhile ago. I noticed I started to get a little moody on day 5 & 6. A friend of mine ended up taking it twice weekly (with the doc's okay, of course).

Is there any way you can put all the things you forget most frequently right by your front door? I used to lose my keys a lot at my old apartment until I put a hook right by my front door.
posted by luckynerd at 11:44 AM on January 12, 2011

My husband keeps his toothbrush INSIDE the SSRI packet.
posted by lollusc at 4:00 PM on January 12, 2011 [3 favorites]

I take Strattera and a low dose of Wellbutrin to manage ADD, and what helps me the most is (a) setting a daily reminder up in Google Calendars which emails me every day at 9:30 asking "Have you taken your meds yet?", and (b) getting one of those seven-day pill holders, and leaving it in my bag, so that it's always with me. That way I only have to remember to refill it once a week, instead of every day.
posted by telophase at 1:12 PM on January 13, 2011

Response by poster: That way I only have to remember to refill it once a week, instead of every day.

Heh. My case is actually a 28-day case, so I actually only have to remember to refill it once a month.

The "MEDS, LUNCH, PHONE, KEYS, WALLET?" sign is up, and seemed to work today, though I realized that I need to add "WATCH?" to the sign, because I forgot that today.

I'm also going to add a calendar reminder, and I stashed some extra pills in my bag. Progress!
posted by ocherdraco at 3:50 PM on January 13, 2011

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