Prozac

Tags: gay

Also known as: Fluoxetine hydrochloride

The statistics about depression are, well, sobering. More than 18 million people in the United States alone suffer from it, two-thirds of whom don't get the help they need, according to the National Institute of Mental Health. Though not as prevalent, obsessive-compulsive disorder and bulimia are two other psychological conditions that often go undiagnosed and can disrupt a person's life. In a survey conducted by GayHealth.com, it was found that depression was the number one health concern of the LGBT communities.

What is it?

Your brain has billions of cells (neurons) which communicate with each other by sending chemical messengers, called neurotransmitters, across bridges (synapses) that link your neurons together. Serotonin is a type of neurotransmitter that has been found to affect your sleep, mood and behavior. Prozac belongs to a group of drugs called serotonin reuptake inhibitors (SSRIs), which keep serotonin from being reabsorbed into its storage spots in the brain. Researchers have found that boosting levels of serotonin by inhibiting its reabsorption helps alleviate symptoms of depression, OCD and bulimia.

How is it used?

Prozac is usually taken in pill form each morning. Like other SSRIs, it may take up to four weeks for your blood levels to rise and for you to feel the full effects of Prozac. That's why it's crucial you take it as prescribed and avoid missing doses. Consult your doctor if you want to increase your dosage or discontinue therapy.

In February 2001, the U.S. Food and Drug Administration approved Prozac Weekly, a once-a-week treatment for patients whose depressive symptoms have stabilized but who need continuing treatment to prevent a relapse of acute depression. If you think this treatment might be right for you, talk to your doctor. Prozac does not work for everyone. If it doesn't work for you, your doctor may want you to try other SSRIs or a different class of antidepressant.

For depression, most doctors advise an initial daily dose of 20 milligrams, though you and your doctor may consider a gradual increase after assessing the drug's effect over a trial period of several weeks. For bulimia, a daily dose of 60 milligrams is usually recommended, though studies indicate that lower doses may also be effective. For OCD, a daily dose ranging from 20 to 60 milligrams is usually recommended.

For the elderly, lower or less frequent doses of Prozac may be recommended. Your doctor may adjust your dose depending on your response to the drug. If you miss a dose, skip it and continue on your regular schedule; don't double up. Prozac comes in 10 and 20 milligram pills and a 20 milligram liquid, both of which can be taken with or without food. Avoid taking more than 80 milligrams a day. Prozac is not a drug that should be taken without a doctor's prescription or supervision.

Don't "borrow" a pill from a friend for a pick-me-up. In low dose, Prozac is beneficial in treatment of premature ejaculation. UPDATE: Generics now available. On August 2, 2001, the U.S. Food and Drug administration gave the go-ahead for drug companies to produce generic forms of Prozac. The generic versions are expected to reduce the cost of the drug by 25 to 40 percent or more.

What are the side effects?

There are several side effects that should be brought to your doctor's immediate attention: itchy rashes, trouble breathing, chest pain, anxiety, feeling agitated, a pounding heartbeat and suicidal thoughts. Other side effects that you should also discuss with your doctor include: nausea, headache, trouble sleeping, tremors, changes in taste (of food, not interior design!) and a decreased libido or impotence. Appetite and weight changes may result from treatment. Significant weight loss may occur -- especially in depressed or bulimic patients who are underweight. Inform your doctor of any side effects you develop while taking Prozac.

Impotence and loss of libido are particularly troubling side effects of the SSRI class of antidepressants -- especially since LGBT people are often reluctant to discuss sexual issues with their physicians. Many times these problems are not addressed because the doctor is unaware. Unfortunately, impotence and loss of libido are not usually dose related. This means that if you have the problem, lowering your Prozac or other SSRI dose may not improve it, and might bring on a worse depression instead. If after starting an antidepressant, you suffer from impotence or notice a falling libido, talk to your doctor. Your doctor may prescribe a different class of medication. Do not suddenly discontinue Prozac if you've been taking it for long periods; you may experience a dangerous withdrawal.

Dangerous complication/interactions

Warning! Do not take Prozac within two weeks of discontinuing a monoamine oxidase (MAO) inhibitor (a type of antidepressant, which includes St. John's Wort), and do not take an MAO inhibitor within five weeks of discontinuing a chronic or high-level dosage of Prozac. An interaction of these two drugs can be fatal.

Consuming alcohol or taking blood thinners, sleeping pills, painkillers, muscle relaxers or certain cold and allergy medications can also cause a dangerous interaction when taken with Prozac. Consult your doctor before taking these or any other medications. Prozac may make you feel sleepy or dizzy. Be careful driving or operating heavy machinery (for you butch boys and girls) until you feel reasonably comfortable with the effects of the drug, which could take up to four weeks to fully develop.

You may also get dizzy when getting up from a chair or bed, so take it slowly. If you have diabetes, kidney or liver disease or seizures, consult your doctor before taking Prozac. Though the effects of Prozac on elderly patients were similar to those in younger people, there is insufficient data to rule out potential problems in the elderly who take Prozac chronically or have other illnesses.