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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Franz on August 4, 2005, at 21:38:41
Hello, what is the status of prozac these days?. Why I do not hear/read more about people using this drug?.
I have a collaborative psychiatrist, we tried different SSRIs but never mentioned Prozac.
I have read good things about it, like long life, activating (which I need), etc.
What do you think?. Is it worth to try when Zoloft and Effexor failed?.
Thanks.
Posted by Emily Elizabeth on August 4, 2005, at 23:23:45
In reply to What about PROZAC?, posted by Franz on August 4, 2005, at 21:38:41
It makes sense to try at least one more SSRI before giving up on them. For whatever reason, some people respond to one, but not another. Actually prozac made me worse, but I think that was the exception and not the rule.
And bonus: Prozac isn't on patent any more and so it is very cheap. Good if you don't have insurance or have a cap to how much insurance will pay.
Best,
EE
Posted by SLS on August 4, 2005, at 23:38:32
In reply to What about PROZAC?, posted by Franz on August 4, 2005, at 21:38:41
To read the posts here, it would seem as if Prozac has fallen into disuse for some reason. I don't feel that this is justified. Perhaps the drug representatives truly are good salesmen. In any event, I would say that Prozac is different enough from the other SSRIs to make it a reasonable choice. However, it might be a good idea to look drugs with differing properties at this point. Tricyclics, Remeron, Wellbutrin, and MAOIs are alternatives that you should keep in mind if you feel that the SSRI route has been fully explored. Remember that the full exploration of these drugs might require high dosages and the use of drug combinations.
- Scott
Posted by blueberry on August 5, 2005, at 5:44:52
In reply to What about PROZAC?, posted by Franz on August 4, 2005, at 21:38:41
Prozac is actually different enough from the others that it is sometimes called an atypical ssri. I have tried all of the ssri's and I like prozac the best. Celexa, paxil, and zoloft all felt pretty similar to me, but prozac feels very different from them. It isn't so emotionally numbing like the others, and it doesn't have bad sexual side effects like the others, to me anyway. It is mildly stimulating and I like that. My only problem with it is that if my dose goes over 20mg, I get agitated. Insomnia is a problem too, so something else is needed for good sleep. I take low dose zyprexa for that.
Prozac was the leader and is still the best in my own experience. The other copycats can be good, but they lack a certain something that prozac has.
Posted by med_empowered on August 5, 2005, at 8:43:40
In reply to Re: What about PROZAC?, posted by blueberry on August 5, 2005, at 5:44:52
It really depends. Prozac is more activating than most other SSRIs..its also less potent on serotonin re-uptake inhibition (mg per mg) than the other drugs. If you experienced anxiety, insomnia, etc. on the other SSRIs, you might want to avoid Prozac. If you tolerated the other SSRIs pretty well, it could be worth a try. Just keep in mind that Prozac has a freakishly long half-life: it takes 5 weeks to wash out completely. So...withdrawal symptoms are better than with other SSRIs (*especially* compared to Paxil), but if you have problems with it...you could be dealing with side effects for a while after you stop taking it. Anyway...usually, an "adequate trial" of two anti-depressants from a given class constitutes an overall "adequate trial" of that class...so, at this point you could, technically, be considered resistant to SSRI therapy. If you have severe depression (but no psychosis or suicidal inclinations), tricyclics may be the way to go, at least for a while; overall, SSRIs and TCAs are equally effective, but TCAs may be better for hard-core "endogenous" depression; "reactive" depression may respond better to the SSRIs. From my experience, I think that if you've had problems treating depression, it may be best to start out your new trial *with* augmenting agents, instead of waiting for a response and *then* augmenting. Buspar, Dexedrine, Adderall, Ritalin, Provigil, Straterra, and the atypical antipsychotics (especially Abilify and Zyprexa) are all potential augmenting agents. Lamictal and Lithium are also sometimes used, but, personally, I'd avoid the side-effects associated with those if possible...however, it depends on your symptoms. One option would be (short-term) treatment with amoxapine, brand name "Asendin". Its a double-whammy: an anti-depressant with antipsychotic effects as well. No one really knows WHY, but it can often treat resistant depression QUICKLY..if it works, it often works within 4-14 days (without augmenting agents). There's a big "poop-out" problem with it though, and it carries the EPS/TD risks associated with antipsychotics (probably at about the same level as the atypicals, but no one seems really sure)....it might be wise to do a switch-over to something else after a while (I did this with Tofranil...I switched to Cymbalta. It worked reasonably well). Anyway, sorry this was so long, but I wish you the best of luck.
Posted by ed_uk on August 5, 2005, at 17:04:32
In reply to Re: What about PROZAC?, posted by SLS on August 4, 2005, at 23:38:32
>To read the posts here, it would seem as if Prozac has fallen into disuse for some reason.
Because it's old(ish) and off patent. Lexapro has been very successfully marketed.
~ed
Posted by ed_uk on August 5, 2005, at 17:12:22
In reply to What about PROZAC?, posted by Franz on August 4, 2005, at 21:38:41
>Hello, what is the status of prozac these days?
Generic fluoxetine is very widely used in the UK. It's similar in efficacy and tolerability to the other SSRIs - with a few minor differences (allegedly).
>Why I do not hear/read more about people using this drug?
........because the newer SSRIs have been VERY effectively marketed. There's nothing specifically wrong with fluoxetine.
>Is it worth to try when Zoloft and Effexor failed?
Since Effexor and Zoloft have failed, I'd recommend trying a completely different type of antidepressant next eg. desipramine.
~ed
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