Prozac Side Effects, Risks, and Treatment

The potential for Prozac abuse and addiction has not been studied extensively. Doctors generally agree that it is not an addictive or dangerous drug for most people. However, you should be aware of certain risks associated with taking Prozac such as negative drug interactions, serotonin syndrome, the increased risk of suicide, and more.
Evidence Based
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What is Prozac?

Prozac (fluoxetine) is an antidepressant medication. It is a selective serotonin reuptake inhibitor (SSRI), which means it increases serotonin in the brain. It improves overall mood and boosts energy levels while also reducing anxiety and the urge to repeat tasks.

Prozac works by balancing unbalanced chemicals in the brains of people with depression, anxiety, panic, or obsessive-compulsive symptoms. It treats major depressive disorder, obsessive-compulsive disorder (OCD), panic disorder, premenstrual dysphoric disorder (PMDD), and bulimia nervosa. 

Prozac is sometimes used off-label to treat generalized anxiety disorder, migraine headaches, diabetic neuropathy, fibromyalgia, and neurocardiogenic syncope. It is also used in combination with olanzapine (Zyprexa) for treating manic depression associated with bipolar disorder or for those who have not had success with other antidepressants.

Graphic of 3 different types of medication bottles and pills.

Prozac Uses & Dosage

Prozac should be used under a doctor’s supervision. Prozac is usually prescribed in doses ranging from 10 mg to 60 mg. Most doctors initially prescribe a low dosage of 10 mg to 20 mg and increase it as needed. Improvement usually occurs within a week or two but it could take up to a month to see improvement. People should take only the dosage prescribed and continue the prescription according to their doctor’s advice.

Different doses of Prozac are used to treat different conditions, including:

  • Major depressive disorder — a single dose of 20 milligrams (mg) per day.
  • Bulimia nervosa —a single dose of 60 mg per day.
  • Panic disorder — a single dose of 10 mg per day.
  • Obsessive-compulsive disorder — a single dose of 20 mg per day.
  • Premenstrual dysphoric disorder — a single dose of 20 mg per day; your doctor may have you take the dose for only 15 days of your menstrual cycle or every day.

It is possible to overdose on Prozac. Symptoms of overdose include

  • Confusion
  • Convulsions
  • Dizziness
  • Fainting
  • Impaired coordination
  • Irregular heartbeat
  • Uncontrollable shaking

Between 2011 and 2014, almost 13 percent of people 12 and over reported antidepressant medication use in the past month.

National Center for Health Statistics (NCHS)
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Risks of Prozac

SSRIs are generally safe for most people. However, you should be aware of certain risks associated with taking Prozac. These risks include negative drug interactions, serotonin syndrome, the increased risk of suicide, and more.

Talk to your doctor if you take drugs that increase your risk of bleeding, including nonsteroidal anti-inflammatory drugs (NSAIDs), warfarin, other blood thinners, or aspirin. Prozac can contribute to your risk of gastrointestinal bleeding and other bleeding problems if combined with these drugs.

Serotonin syndrome is a condition that occurs when high levels of the neurotransmitter accumulate in your body. This most often occurs when two medications that increase serotonin levels are combined. Examples of these include other antidepressants, the herbal supplement St. John’s wort, and certain pain and headache medications. Signs of serotonin syndrome include:

  • Confusion
  • High fever
  • Sweating
  • Rapid heart rate
  • Changes in blood pressure
  • Nausea/vomiting
  • Tremors
  • Anxiety or agitation
  • Restlessness
  • Lack of coordination
  • Coma
  • Diarrhea

If you have any of these symptoms, contact emergency medical services immediately.

The Food and Drug Administration (FDA) requires that all antidepressants carry black box warnings, used only for serious safety concerns. SSRIs like Prozac can increase suicidal thoughts or actions in children, teenagers, and young adults under 25. These are most likely to occur in the first few weeks of beginning treatment or when the dose changes.

If you begin to have suicidal thoughts while taking Prozac, contact emergency medical services or your doctor immediately. It is important to remember that the overall goal of antidepressants is to reduce suicide risk over time.

Prozac may cause hyponatremia, a condition that occurs when the concentration of sodium in your blood is too low. SSRIs interfere with the kidneys and normal hormonal processes in the brain, resulting in an imbalance in electrolytes. Signs of hyponatremia to look out for include:

  • Headache
  • Nausea and vomiting
  • Seizures
  • Coma
  • Memory impairment
  • Confusion
  • Muscle cramps, spasms or weakness
  • Irritability and restlessness
  • Drowsiness and fatigue
  • Difficulty concentrating

In severe cases, hyponatremia results in hallucinations, respiratory arrest, and death. If you experience any of the above symptoms, contact medical emergency services immediately.

Do not take Prozac with monoamine oxidase inhibitors (MAOIs). These drugs are another type of antidepressant, and when they are combined with Prozac, can become dangerous. If you discontinue use of MAOIs, you must wait two weeks before taking Prozac. On the other hand, if you discontinue use of Prozac, you must wait five weeks before taking an MAOI.

Serious side effects can occur if use of the two drugs overlaps, including:

  • Confusion
  • Restlessness
  • Seizures or severe convulsions
  • Agitation or irritability
  • Extremely high blood pressure
  • Stomach or intestinal problems
  • Restlessness
  • High body temperature
Graphic human body showing symptoms.

Side Effects of Prozac

Common side effects due to Prozac use include:

  • Headache
  • Nausea
  • Restlessness
  • Fatigue
  • Insomnia
  • Diarrhea
  • Increased sweating
  • Dry mouth

These symptoms will begin to improve over the first week or two of treatment. SSRIs like Prozac take four to five weeks to reach steady-state, or a constant concentration of the drug in your blood. This state is when you will get the full benefits from the drug. Furthermore, it is important to continue taking Prozac even if you feel well in order to maintain steady-state and properly treat your condition.

It is also common to experience undesirable sexual side effects when taking SSRIs, such as problems with orgasms and ejaculatory delay. These do not tend to improve over time.

Prozac can also trigger severe side effects. You should seek immediate medical attention if you experience:

  • Irregular heartbeat
  • Impaired judgment or motor skills
  • Abnormal bleeding
  • Allergic reactions
  • Suicidal thoughts and behaviors
  • Serotonin syndrome
  • Mania/hypomania
  • Vision problems
  • Seizures
  • Severe weight loss
Two pills mixing equals dangerous

Drug Interactions

There are more than 600 drugs known to interact with Prozac, 140 of which are major. They include:

  • Adderall (amphetamine / dextroamphetamine)
  • BuSpar (buspirone)
  • Cymbalta (duloxetine)
  • Phentermine
Graphic of speakerphone showing risk factors.

Is Prozac Addictive?

Prozac does not cause addiction or induce physical cravings in the same way other drugs do. Most people don’t neglect daily responsibilities chasing a Prozac high because there is no immediate effect or a euphoric rush of dopamine from the drug. Prozac doesn’t induce cravings or cause people to take dangerous risks. However, someone can become dependent on Prozac. This occurs when the brain adapts to the drug and requires it to function normally.

In most cases, Prozac abuse involves increasing the prescribed dosage of the drug because a person doesn’t think it’s working fast or effectively enough.

Prozac affects serotonin levels in the brain and in some cases, the original symptoms Prozac was prescribed to treat will return, sometimes more severely if Prozac use stops. Users also experience withdrawal symptoms if they stop using Prozac suddenly.

Abusing Prozac increases the risk of dependence.

Graphic of head filled with pills

Prozac Addiction Symptoms

People who misuse or abuse the drug might exhibit signs of a problem even if there is no addiction. Signs of Prozac abuse include:

  • Aggression
  • Hyperactivity
  • Insomnia
  • Irritability
  • Jitters
  • Lack of emotion
  • Numbness
  • Talkativeness
  • Violent thoughts and actions

Graphic of woman going through withdrawal.

Withdrawal Symptoms

Prozac relieves symptoms of unpleasant disorders and makes a user “feel better.” If he or she stops using it and experiences withdrawal. Withdrawal from Prozac triggers something known as antidepressant discontinuation symptoms. These last about two or three weeks and include:

  • Agitation and restlessness
  • Confusion and slow thinking
  • Dizziness or vertigo
  • Excessive sweating 
  • Mild to severe headaches
  • Insomnia 
  • Fatigue or lethargy
  • Anxiety 
  • Mood swings 
  • Memory and concentration problems
  • Numbness
  • Tingling

Brain zaps are another symptom of withdrawal from antidepressants. They are an unpleasant buzzing or electrical shock sensation. Brain zaps might be accompanied by dizziness or pain. They occur because of the alterations in the neurotransmitters in the brain and are frightening and uncomfortable.

The safest method of discontinuing use of Prozac is under direct care of a medical professional. The mental health conditions treated by the drug are serious and require continued treatment.

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Prozac Treatment

Current research suggests that Prozac is not addictive. Therefore, there is little information on treatment and few resources available on the topic.

Talk to your doctor if you are concerned about possible addiction and if you have a history of drug abuse. There are many different SSRIs available to treat a wide variety of mental health conditions, and switching medication may help.

Talk with your doctor today about Prozac use and possible treatment alternative options.


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Resources

Food and Drug Administration. “Prozac (fluoxetine hydrochloride) capsules label.” FDA, https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/018936s091lbl.pdf

Mayo Clinic. “Fluoxetine (Oral Route).” Mayo Clinic, Feb. 2020, https://www.mayoclinic.org/drugs-supplements/fluoxetine-oral-route/description/drg-20063952

Mayo Clinic. “Hyponatremia.” Mayo Clinic, May 2018, https://www.mayoclinic.org/diseases-conditions/hyponatremia/symptoms-causes/syc-20373711?page=0&citems=10

Mayo Clinic. “Selective serotonin reuptake inhibitors (SSRIs).” Mayo Clinic, Sept. 2019, https://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825

National Alliance on Mental Illness. “Fluoxetine (Prozac). NAMI, Dec. 2018, https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications/Types-of-Medication/Fluoxetine-(Prozac)

Pratt, Laura A., Brody, Debra J., Gu, Qiuping. “Antidepressant Use Among Persons Aged 12 and Over: United States, 2011-2014.” National Center for Health Statistics, Aug. 2017, https://www.cdc.gov/nchs/data/databriefs/db283.pdf

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Updated on: July 1, 2020
Author
Addiction Group Staff
About
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Medically Reviewed: April 17, 2020
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Annamarie Coy,
BA, CADACII/ICADC, ICPR, MATS
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