I've been prescribed Fluoxetine (Prozac), should I take it?
November 9, 2014 12:41 PM   Subscribe

To be honest, I don't know if I'm currently depressed. I do have some of the symptoms of depression but these tend to come and go: low mood, irritability, poor sleep, poor appetite, difficulty concentrating, negative thinking (I've had this one most of my life). I also suffer from anxiety and get stressed very easily - my personality is highly neurotic. Some days I feel pretty okay but my mood really goes down when I get home from work and especially on the weekends when I'm spending a lot of time alone in my room.

I've seen my doctor before about therapy but have been unable to attend as all of the programs being offered on the NHS are run during working hours (I work full time). I can't afford private therapy.

I saw my doctor again this week and described my symptoms, he prescribed me Fluoextine (Prozac) to see if it would help me (along with telling me to exercise, eat healthy and socialise more). Initially I was optimistic about taking them but then started reading up on the side effects and freaked myself out. I'm prone to medical anxiety and reading about things like Post-SSRI Sexual Dysfunction really terrified me.

I'm not worried about taking medication but if it was to affect permanently, that to me is unacceptable. My sex drive already isn't particularly high so the idea of it likely being negatively affected (a common symptom) is also very offputting.

Am I just being overly cautious? Do I even need to take the medication if I'm not necessarily depressed? Also, any personal experiences of taking Prozac would be much appreciated.
posted by fallingleaves to Health & Fitness (22 answers total) 4 users marked this as a favorite
Simply put - any side effects of fluoxetine are temporary. If you do have sexual dysfunction from fluoxetine just stop the medicine and things will go back to normal.
This is a common misconception about SSRIs.
posted by arrmatie at 12:55 PM on November 9, 2014 [2 favorites]

Well, being depressed also messes up your sex drive and performance, as well as your enjoyment of relationships and all sorts of other things. As does anxiety -- including your worry about all of this. There's a non-zero chance of these things affecting you, but it affects people differently, so there's no way of knowing. And as far as I know, nothing is permanent.

I've taken Prozac, Zoloft, Celexa and Effexor (at different times, including significant time off with no issues). They've worked differently for me at different times of my life. I tend to have a low drive as well, but I enjoy the experiences I have so much because I enjoy the whole experience, period.

It's worth trying.
posted by Madamina at 12:59 PM on November 9, 2014

I have taken it in the past and it helped me out with the most acute and debilitating aspects of anxiety and depression (although I also used other techniques, such as therapy and lifestyle changes, to help with longer-term management). I had some insomnia while taking it, but it caused far less severe side effects than paroxetine, and they went away when I stopped the drug. Sexual side effects, in my experience, tend to decrease with continued use (and depression itself is an anti-aphrodisiac, anyhow).

Virtually every medication out there has caused horrifying side effects for someone at some time. If a drug is approved for clinical use, it means that the potential benefits for most patients outweigh the likelihood of their experiencing severe side effects. I suggest you talk to your GP about your concerns (you should be having regular medication reviews, anyway); he will help you to interpret the statistics.

When searching for information on the Internet, be aware that there are a lot of very vocal people out there who are opposed to anti-depressant medication for reasons that have little to do with science.

If you really trust the advice of a Stranger on the Internet (tm) more than the advice of a doctor who has actually examined you, then my advice is: Yes, give it a try.
posted by Perodicticus potto at 1:01 PM on November 9, 2014 [1 favorite]

I've written before about my two experiences with Prozac, if you find that useful.

To address side effects more specifically since you're asking about those - no side effects I experienced were permanent. Some went away within ~3 weeks of being on the medication, and one or two stuck around for the entire time I was on the medication but went away shortly after I stopped taking it.

You might want to read about dysthymia a bit, and see if it sounds familiar to you. When people talk about "depression" they are often talking about major depressive episodes, but that isn't the only way to have depression. You can have major episodes, but you can also have dysthymia - sort of a low-level chronic depression that is never really really terrible but also never lets you live your life as fully as you want to. You can have both together, or one without the other. The beginning of your post sounds to me not entirely dissimilar from dysthymia, and if that's what you have, you may find medication helps. If you're like me, you may find medication helps enough that once the burden is off a bit, you can use your new freedom to develop some better coping mechanisms, and then maybe those can take the place of medication.

As I noted in the first part of the post I linked - medication does not have to be forever. It is a tool you can try. It is a tool you can put down, albeit carefully, if you decide it is not the tool you need for the problem you have, after you've tried it out.
posted by Stacey at 1:04 PM on November 9, 2014 [1 favorite]

I think most people who have depression have symptoms come and go a bit.

I don't think Prozac lowered my libido. It did have some sexual side effects the most recent time I tried it but those went away when I stopped taking it.

If taking meds doesn't feel totally right to you, can you arrange to take time off of work for the therapy/NHS programs you mention? Perhaps you could come in early or work late some days to offset the time. I'm not sure if these things work differently (legally speaking) in the UK than in the US, but would you have this hesitation to take time off work for a root canal or physical therapy for an injured leg? This is the same.
posted by needs more cowbell at 1:05 PM on November 9, 2014

The reason the research looks like SSRI's don't work very well is that people have hugely varied reactions: some people get way, way better and some get way way worse, some have small positive effects, some small negative effects and this cancels out in the data and looks like nothing changed.

It's like Bill Gates walking into a bar and massively raising the average income and then leaving again and lowering it. And worse, you get certain journalists and psychiatrists who simply write about how evil it is or how great it is or how placebo it is, ignoring all the data that doesn't fit their preconceived ideas. And it's bizarre that we still have these debates like Prozac: Poison, Panacea or Placebo? It's all three, depending on the person.

Which makes sense since what it tends to do is reduce over-reactivity. If you are highly oversensitive to the point where your reaction to other people's emotion is to run away rather than help or if you tend to get too tangled in your own distress to be able to connect with people, Prozac will improve your relationships, because you will be able to be more present for other people. If your natural temperament is to be somewhat numb and under-reactive, it could, alternatively, make you less there for other people.

So, depending on your baseline, it's either a great or a terrible drug. And sometimes, you may not know your baseline until you try it.

I've never heard of anyone having side effects that didn't go away after the drug is stopped and out of the system: if these occur, they are extremely rare.

For me, SSRI's made a massive positive difference: I'm how I am when I'm not overwhelmed by stress— ie, a lot happier and a lot better at relationships.

I don't see any reason not to try it: if it doesn't work or makes you feel worse, you stop taking it. That's what my friends did who had bad reactions. Since I write about this area, I've talked to many, many people about it and the main thing I've concluded is that it's really impossible to know how someone will react to a drug unless they try it.
posted by Maias at 1:28 PM on November 9, 2014 [3 favorites]

Post-SSRI sexual dysfunction with Prozac and many other SSRIs is real, and very common. Note that it may not be a decrease in libido per se - it may actually impact basic sexual functioning when desire is still present. That said, the side effects will go away not long after stopping the medication.

My personal position is that you should not take any medication you are not comfortable taking, so long as the risk is low - ie, you are functioning (going to work, eating, interacting with others, paying the bills) and there is little sign of your symptoms worsening. If the way you feel isn't bad enough to be worth a month of experimentation with the side effects of Prozac (or any other medication), and things aren't getting worse rapidly, then no, of course you shouldn't take it.

Have you asked your doctor why they prescribed an anti-depressant and not an anti-anxiety medication? You yourself acknowledged that you suffer from anxiety, your described symptoms are largely shared by depression and anxiety, and there's little in your description that isn't indicative of anxiety being the predominant problem.

Many doctors will not immediately prescribe an anti-anxiety medication such as a benzodiazepene (Valium, Xanax, Klonopin), because anti-anxiety medications can be very mildly addictive and anti-depressants usually are not. However, anti-anxiety medications have some real advantages - they can work nearly immediately to relieve anxiety (versus 3 weeks of ramp-up time with many SSRIs such as Prozac), test very favorably against placebo across the population (whereas, as alex1965 linked, anti-depressants generally don't do much better than placebo, and anti-depressants seem to do random things to people), and generally have much more limited side-effects than SSRIs.

I'm certainly not a doctor, and I'm not your doctor, but if your doctor prescribed Prozac without much discussion of a medication plan, and without talking to you about common side effects, and was just prescribing it based on you checking boxes on a survey versus an in-depth discussion about anxiety and depression - which is what it sounds like to me - yes, I'd really think twice and hold off for now. Your best bet may be to go get a second opinion, and explain your concerns with Prozac and reiterate the problems you face. If anxiety's the big problem, and you're not being treated for that, you should make that front and center in the discussion.
posted by I EAT TAPAS at 1:31 PM on November 9, 2014 [2 favorites]

I recently started taking a similar SSRI, and it's been great. While it didn't solve my depression or anxiety, it reduced the symptoms. I feel like I can much more easily work on addressing the causes behind my depression now.

Keep in mind that SSRIs take some time to kick in. Two to six weeks isn't unusual. Consider that we're well into November, and the stressful holiday season is virtually upon us. If you typically have trouble dealing with the holidays (or with 3-4 months of dull, gloomy weather), the sooner you start your meds, the better.

I feel like antidepressants have gotten a really bad reputation, and for most of my life, I was highly skeptical. And it's no wonder: the older meds were brutal. Consider that SSRIs are the most commonly prescribed medication in the US. Some people think that this is a negative thing, and that people are taking an easy way out. In my opinion, antidepressants are common because the modern world is so effed up (evolutionarily speaking) that they're almost a basic requirement. Humans aren't built to sit at desks all day, stare at screens, deal with bizarre social structures and seemingly arbitrary rules. But that's the world we live in. And if a little pill safely takes the edge off so you can deal, then that seems OK to me.
posted by joebakes at 1:32 PM on November 9, 2014

Have you asked your doctor why they prescribed an anti-depressant and not an anti-anxiety medication? You yourself acknowledged that you suffer from anxiety, your described symptoms are largely shared by depression and anxiety, and there's little in your description that isn't indicative of anxiety being the predominant problem.

FWIW, I'm on Prozac for anxiety and it works for me. I have no idea if that's super unusual, but I've switched providers without a raised eyebrow. I had a long history of anti-depressants not working for me (and presenting with depression as my primary complaint, not anxiety) and it was one thing that wasn't really closely related to anything that had failed in the past and it's cheap, so we tried it.
posted by hoyland at 1:43 PM on November 9, 2014

"exercise, eat healthy and socialise more"

Regardless of what you decide about Prozac, do take these pieces of advice seriously. These things take effort — effort that can be especially hard to muster if you are feeling depressed — but they will all help you feel better, whether you elect to try Prozac or not. I'm also prone to anxiety, stress, and neurosis. I don't take antidepressants anymore, though I used to. On them and off them, exercise, socializing, and my diet really affected, and continue to effect, my mood.
posted by toomuchkatherine at 3:53 PM on November 9, 2014

I've got a couple thoughts: if you're regularly worried about getting into low moods, then there is a problem. Here's an essay by someone pretty successful who nevertheless didn't realise she doesn't have to be miserable or anxious on any frequent basis. She's put it far better than I could, and honestly, at the moment I'm jealous of people who have not being miserable as an immediately achievable goal. I'm further down the spiral and can honestly say there are no redeeming features to any of those symptoms you mentioned.

In terms of whether it's anxiety or depression, NHS GPs don't prescribe anti-anxiety medication for regular use and the first line treatment is SSRIs and talking therapy. I think English* mental health trusts are under some obligation to run out of hours sessions for their first line psychological therapies clinics, and you don't need a GP referral to go to these. Search for "mental health PALS**"+your region to call and ask about weekend and evening clinics and how they take referrals. IAPT*** is the name of the first line talking therapies clinics.

Hopefully that's useful. A much happier easier life may be within your reach if these things work out.

*sorry if you're in another part of the UK: I only know England
**Patient Advice and Liaison Service
***Improving Access to Psychological Therapies
posted by ambrosen at 4:40 PM on November 9, 2014 [3 favorites]

SSRIs are extremely commonly used and safe drugs.

I have two acquaintances who are psychiatrists so I just asked them what they knew about "Post SSRI Sexual Dysfunction". They both said they had never heard of it. These are board certified psychiatrists. I also googled around and I saw multiple other references that noted that it was controversial whether this exists or not.

Obviously, there are people who claim that it does exist, as evidenced by the page you found (which has references to case reports etc), and I'm not going to say it doesn't exist, but it does seem like if you're spending any significant time worrying about something that (at least some) psychiatrists haven't heard of and which may or may not be something that actually happens, you may be being overly cautious. Sexual dysfunction is a common side effect of SSRIs, though, but if you find that it's a problem you can stop the med.

If you feel that your symptoms are not greatly impacting your life, there is always the possibility of trying your best with lifestyle changes like diet and exercise first for a few months and then trying medication if that does not work. If you specifically are terrified of Prozac/sexual dysfunction, you could ask your doctor whether bupropion would be an equally reasonable choice for you, since it is not associated nearly as much with sexual dysfunction, but keep in mind that if you google bupropion or any other drug you will find some scary rare side effects for them too. You are always able to ask your doctor if there are other options that they would recommend for you. Your symptoms sound pretty debilitating to me, and I hope you find a solution that works for you and improves your mood.

If it helps, I also took Prozac for a period of time a long time ago (about 2 months) and had zero side effects with it (also zero effects, but I don't regret trying it).
posted by treehorn+bunny at 5:20 PM on November 9, 2014 [1 favorite]

crazymeds.us has a lot of information about SSRIs, but no mention of post-SSRI syndrome.
posted by Johnny Wallflower at 6:12 PM on November 9, 2014

ambrosen, that essay link doesn't work.
posted by Blitz at 7:17 PM on November 9, 2014

"Am I just being overly cautious?"

No, I don't think so. When it comes to something as important as your mental health, you should be very careful and gather as much information as you can (from diverse sources) before you make a decision. I think you are also wise to be concerned about side-effects of any drugs you take, not just the psychoactive ones.

"I'm not worried about taking medication but if it was to affect permanently, that to me is unacceptable."

You've already uncovered some information about the sexual side-effects of Prozac. You might also consider reading about the long-term effects on your mood.

"[My doctor advised me to] exercise, eat healthy and socialise more"

That sounds like excellent advice. Exercise, in particular, is safe and has been proven to improve your brain function.
posted by alex1965 at 8:05 PM on November 9, 2014

Sorry, I messed-up the last link in the post above. I meant to link to an interesting book I just finished reading. It's called, Spark: The Revolutionary New Science of Exercise and the Brain.
posted by alex1965 at 8:51 PM on November 9, 2014

Considering my own experiences with SSRIs, considering what I've learned in nursing school, considering that you've never been on them before, and that you've been like this for a while:
I would vote to try it.

But Alex is correct that a regular semi-strict routine for sleep, eating, and exercise can also make a HUGE difference.

Perhaps try a routine while continuing the debate on the prozac?
posted by MeiraV at 9:32 PM on November 9, 2014

There are lots of antidepressants, but there's no way to predict which one, if any, will help you. You just have to try. As for safety, fluoxetine has been used by millions of people since 1987. Some people have side effects, and if you are one of them, you stop taking it and try something else. It's not that complicated.

I disliked the first antidepressant I tried. There were side effects, including "loss of libido" as they say on the label. It also made me feel emotionally numb. I switched to a different antidepressant, and I've never looked back. The second drug helped me feel more like my normal nondepressed self. I'm so glad I tried medication.

There have also been clinical trials showing the benefits of exercise, so that was a good recommendation. And many depressed people do feel better if they spend time with family and friends, even though it may seem hard to make the effort. Some people find B vitamins helpful, so eat those leafy greens and try to avoid carbs: pasta, bread, sweets. If you have trouble with insomnia, try to get out in the sun early in the morning. That will tune up your biological clock.

If you can't get to therapy, you can try reading Feeling Good by David Burns. It explains many of the things you'd learn in cognitive behavioral therapy. It's not as good as actual therapy, but you may find it useful.

And please keep in mind that depressed people are great at coming up with excuses for inaction.
posted by islandeady at 10:20 PM on November 9, 2014 [2 favorites]

The "just stop the medicine and things will go back to normal." advice borders on criminal. Don't EVER just STOP an antidepressant without direction from your doctor. Seriously. don't.
posted by littleredwagon at 11:37 AM on November 10, 2014

Little red wagon is right, at least if you've been taking it for a couple weeks or more. I tapered very slowly off a medium dose of one and it wasn't too bad but it wasn't fun either. I don't like to think about what it would have been like to do it suddenly...
posted by K.P. at 1:16 PM on November 10, 2014

To clarify, I believe what littleredwagon is referring to is antidepressant discontinuation syndrome. Some people who discontinue SSRIs get unpleasant symptoms when they stop. Such symptoms don't often occur with Prozac because it has a very long half life. You can check it out yourself and see what you think. I doubt anyone here would advocate for changing strategy with medications without discussing it with your doctor.
posted by treehorn+bunny at 10:23 AM on November 11, 2014

Littleredwagon, that's not quite right: if you are *starting* a medication and have a bad side effect, especially suicidal thoughts or intense restlessness, you absolutely should stop taking it immediately and call your doctor and your friends. The question is about someone starting meds, not someone who has taken them long enough for this to be an issue— and it typically only becomes one if someone has taken the drugs for months.

Further, Prozac is one of the drugs that is the least likely to have any withdrawal symptoms because it is extremely long acting: the one you shouldn't take unless absolutely nothing else works because the withdrawal is quite nasty is Paxil.
posted by Maias at 2:50 PM on November 12, 2014

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