What are the long-term effects of taking Prozac? I've been taking 20 mg/day for almost a year.
— Happy, but at what cost?
Dear Happy, but at what cost?,
Prozac (generic name: fluoxetine) is one of the most common antidepressants in the United States. It’s prescribed to treat major depressive disorder (adult and pediatric), obsessive-compulsive disorder (adult and pediatric), acute depressive episodes in Bipolar I disorder, panic disorder, bulimia nervosa, and premenstrual dysmorphic disorder. It’s in the selective serotonin reuptake inhibitor (SSRI) family of drugs, meaning it works by altering the action of the neurotransmitter serotonin. Fluoxetine is considered to have fewer side effects compared to other antidepressants, and short-term side effects typically — but not always — go away within one to two weeks from starting the medication (if they don't, it's best to talk to a health care provider). However, there are indeed possible long-term side effects to be aware of when taking fluoxetine.
Possible long-term side effects include:
- Bone fractures and osteoporosis: There is some research that indicates that long-term SSRI use could lead to bone fractures and osteoporosis. As mentioned briefly above, SSRIs work by inhibiting the re-uptake of the neurotransmitter serotonin into serotonin receptors. One of the many places serotonin receptors exist are in osteoblasts and osteoclasts — the cells that form and re-absorb bone. Accordingly, serotonin may be important in the functioning of these types of cells, suggesting that inhibiting the re-uptake of serotonin into receptors on these cells might have effects on the way that bone is made in your body. This might cause bone fractures — one of the symptoms of osteoporosis. Due to the increased risk of osteoporosis, some researchers recommend changing medications if fluoxetine is taken for more than five years.
- Psoriasis: This chronic skin disease (causing intermittent red, itchy patches on the skin) may be brought on or exacerbated by taking fluoxetine. Serotonin plays a role in both cell reproduction and inflammation, and both serotonin receptors and the related transporter protein have been identified in skin with psoriasis. However, researchers have reported few cases of this long-term side effect.
- Sexual dysfunction: This could be considered both and short- and long-term effect. Fluoxetine often reduces sexual desire and can delay or interfere with orgasm, in both women and men. When compared to other SSRIs, however, the sexual side effects may not be as strong with fluoxetine.
- Risk of suicidality: This risk is associated with beginning treatment with fluoxetine, but also anytime the dosage is increased or decreased throughout the duration of treatment. Previously thought to only affect users under the age of 25, fluoxetine is now considered to potentially increase the risk of suicide for anyone taking it. Immediately reporting any changes in mood or suicidal thoughts to your psychiatrist can ensure any proper modifications are made to your dosage.
Although many of the side effects of fluoxetine use subside within a few weeks, some of the potential long-term side effects may last throughout the duration of taking it. In some cases, some may even continue after stopping the medication. These long-term side effects do not occur in everyone, but they do occur in some people taking the drug. If you are concerned about long-term side effects and you want to stop using it, it’s best to talk to your health care provider first. Stopping fluoxetine is best (and safely) done under psychiatric supervision. Quitting the medication abruptly or after a fast taper can also cause withdrawal symptoms or other unpleasant effects.
Want more information? A great resource is your pharmacist, who can answer more specific questions about fluoxetine. You might also talk with your health care provider or the medical professional prescribing your medication if you are concerned about long-term effects.Alice!