Posts Tagged Prozac
[WEB SITE] Prozac vs. Zoloft: What are the differences?
Posted by Kostas Pantremenos in Depression, Pharmacological on July 13, 2019
Prozac and Zoloft are both selective serotonin reuptake inhibitors (SSRIs). This class of medication is among the first options for treating major depressive disorder, which people usually call depression.
Fluoxetine is the generic drug name for Prozac, and sertraline is the generic name for Zoloft.
In this article, we discuss the differences between Prozac and Zoloft.
What do they treat?
Taking either Prozac or Zoloft will increase the levels of serotonin in the brain.
The Food and Drug Administration (FDA) have approved both Prozac and Zoloft for treating:
- major depressive disorder (MDD)
- obsessive-compulsive disorder (OCD)
- panic disorder
- premenstrual dysphoric disorder
In addition, the FDA have approved Prozac for the treatment of:
- bulimia
- binge eating disorder
- bipolar depression
- treatment resistant depression
Doctors may also use Zoloft to treat post-traumatic stress disorder (PTSD) and social anxiety disorder.
Some doctors prescribe Prozac for social anxiety disorder in adults, borderline personality disorder, Raynaud’s phenomenon, and selective mutism, but the FDA have not approved these uses.
Other SSRIs include:
- escitalopram (Lexapro)
- vortioxetine (Trintellix)
- citalopram (Celexa)
- fluvoxamine (Luvox)
- paroxetine (Paxil)
- vilazodone (Viibryd)
Forms
Both Prozac and Zoloft are available in the forms of a liquid oral solution, a tablet, and a capsule.
The following table lists the different forms of each drug along with the available dosages in milligrams (mg) and milligrams per milliliter (mg/ml).
| Prozac | Zoloft | |
| Capsule | 10 mg, 20 mg, 40 mg, 90 mg | 25 mg, 50 mg, 100 mg |
| Tablet | 60 mg | 25 mg, 50 mg, 100 mg |
| Liquid | 20 mg/5 ml | 20 mg/ml |
How to take and dosage
When a person first starts taking antidepressants, they will typically begin on a smaller dosage and increase this over time. Doing this makes it possible to test how well the drug works and monitor its side effects, as the effectiveness and adverse effects can differ among individuals.
American Psychiatric Association guidelines report the following starting dosages and the usual effective dosages when treating MDD:
| Prozac | Zoloft | |
| Starting dosage | 20 mg/day | 50 mg/day |
| Usual effective dosages | 20–60 mg/day | 50–200 mg/day |
Some people may see improvements in their symptoms in the first 1–2 weeks of treatment, whereas it may take 2–4 weeks for others to notice changes.
Some studies have shown that all antidepressants require at least 4–6 weeks before they reach their maximal clinical effectiveness.
There are three phases of MDD therapy:
- The acute phase. The goal of the acute phase is for the person to recover from depressive symptoms and return to their baseline of functioning. This phase will last about 6–12 weeks.
- The continuation phase. During the continuation phase, doctors will recommend that people continue treatment for 4–9 months to prevent symptoms from returning.
- The maintenance phase. Some people may need to continue their medication for longer and complete a maintenance phase. The goal is to protect at-risk people from recurring depressive symptoms.
Doctors will usually recommend a maintenance phase for people with recurrent MDD or chronic depression.
If a person does not have a satisfactory response to medication, the doctor may try increasing the dosage. However, a higher dosage may cause more side effects, so doctors need to evaluate the risks and benefits of increasing it.
Another strategy to increase the effectiveness of the therapy is to add another medicine. A doctor may advise a person to combine Prozac or Zoloft with certain other antidepressants and other types of medication to improve their symptoms.
The doctor will determine which combinations are the most appropriate for each person while keeping in mind the possibility of drug interactions.
Doctors may also adjust medication dosages and regimens for people who are combining medication therapy and psychotherapy.
Side effects
As Prozac and Zoloft are both SSRIs, people may experience similar side effects with these drugs.
Zoloft is more likely than Prozac to cause gastrointestinal tract side effects, such as nausea and diarrhea. Men taking Zoloft may also report more sexual dysfunction side effects, such as failure to ejaculate, than those using Prozac.
However, people taking Prozac more often experience headaches, nervousness, and a lack of energy.
The following table lists the most common side effects of Prozac and Zoloft, which occur in at least 5% of people.
| Prozac | Zoloft | |
| nausea | 22% | 26% |
| diarrhea | 11% | 20% |
| constipation | 5% | 6% |
| decreased appetite | no data available | 7% |
| anorexia | 10% | no data available |
| acid reflux | 8% | 8% |
| dry mouth | 9% | 14% |
| sweating | 7% | 7% |
| insomnia | 19% | 20% |
| drowsiness | 12% | 11% |
| anxiety | 12% | no data available |
| agitation | no data available | 8% |
| nervousness | 13% | no data available |
| dizziness | 9% | 12% |
| tremor | 9% | 9% |
| headache | 21% | no data available |
| weakness/lack of energy | 11% | no data available |
| flu-like symptoms | 5% | no data available |
| decreased sex drive | no data available | 6% |
| failure to ejaculate | no data available | 8% |
Warnings
When people are ready to come off their antidepressant medications, they should do so gradually. Stopping Prozac, Zoloft, or any other antidepressant abruptly can cause discontinuation symptoms.
Discontinuation symptoms may include:
- dysphoria, or general unease and dissatisfaction
- irritability
- agitation
- dizziness
- electric shock sensations
- anxiety
- confusion
- headaches
- lethargy
- emotional lability, or rapid and exaggerated changes in mood
- sleeplessness
Several short-term studies have shown that children, adolescents, and young adults under 24 years old have an increased risk of suicidal thoughts and behaviors when taking any antidepressants.
Doctors will monitor people taking Prozac, Zoloft, or any other antidepressant for worsening of depressive symptoms, suicidal thoughts, and unusual behaviors.
People with glaucoma and a history of seizures should use Prozac, Zoloft, and other SSRIs with caution because the drugs can make these conditions worse.
Suicide prevention
- If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Call 911 or the local emergency number.
- Stay with the person until professional help arrives.
- Remove any weapons, medications, or other potentially harmful objects.
- Listen to the person without judgment.
- If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.
Interactions
SSRIs, including Prozac and Zoloft, have similar drug interactions.
Serotonin syndrome
Feelings of agitation and restlessness can indicate serotonin syndrome.
Serotonin syndrome is a potentially life-threatening interaction that occurs as a result of combining drugs that increase serotonin in the body.
Doctors should avoid prescribing Prozac, Zoloft, and other SSRIs alongside the following drugs:
- triptans
- tricyclic antidepressants (TCAs)
- fentanyl
- lithium
- tramadol
- tryptophan
- buspirone
- amphetamines
- St. John’s wort
- monoamine oxidase inhibitors (MAOIs)
Some of the signs and symptoms of serotonin syndrome include:
- agitation
- anxiety
- restlessness
- disorientation
- sweating
- a high body temperature
- increased heart rate
- nausea
- vomiting
- shaking
- muscle rigidity
- overactive reflexes
- abnormal muscle contractions
- dilated pupils
- abnormal eye movements
- dry mucous membranes
- flushed skin
- increased bowel sounds
MAOIs
People cannot take MAOIs, another type of antidepressant, with Prozac, Zoloft, or any other SSRIs because the risk of developing serotonin syndrome is very high.
Anyone taking an MAOI must stop taking it at least 2 weeks before starting SSRI treatment.
QT prolongation
Doctors have reported QT prolongation in people taking Prozac and Zoloft. QT prolongation is a potentially fatal heart rhythm dysfunction.
This heart condition is more common in people who take other drugs that can prolong the QT interval on an electrocardiograph. These include certain antipsychotics, antibiotics, and anti-arrhythmic medications.
Abnormal bleeding
Some people can experience abnormal bleeding when combining Prozac, Zoloft, and other SSRIs with drugs that can increase bleeding, such as:
Cost
The following table compares the lowest available prices of Prozac and Zoloft:
| fluoxetine | Prozac | sertraline | Zoloft | |
| Capsule (30 capsules) | 10 mg: $3.00 20 mg: $3.00 40 mg: $3.00 |
10 mg: $461.85 20 mg: $474.70 40 mg: $947.40 |
no information available | no information available |
| Tablet (30 tablets) | 10 mg: $4.00 20 mg: $26.76 60 mg: $96.35 |
no information available | 25 mg: $3.99 50 mg: $7.17 100 mg: $6.52 |
25 mg: $313.61 50 mg: $313.61 100 mg: $313.61 |
| Liquid oral solution (1 bottle) | 120 ml: $12.81 | no information available | 60 ml: $25.10 | 60 ml: $216.18 |
Can you take Prozac and Zoloft together?
People should not take Prozac and Zoloft together. These drugs are in the same drug class and have the same actions. Taking both drugs will not improve symptoms but can cause additional side effects.
When people are not feeling the intended effects of either Prozac or Zoloft, the doctor may increase the dosage or alter the treatment regimen by adding another antidepressant or antipsychotic drug that has different actions on the brain.
Summary
Prozac and Zoloft are part of the same family of antidepressants, and both raise the levels of serotonin in the brain. Both drugs have FDA approval for the treatment of MDD, and they also have other approved and nonapproved uses.
The safe warnings relating to taking Prozac or Zoloft are similar, as are many of the side effects, although these can vary from person to person. Zoloft may be harsher on the stomach, while Prozac is more likely to cause headaches.
Both drugs are generally effective and safe, but people taking Prozac or Zoloft should follow up with their doctor to discuss their symptoms and side effects to ensure that they are taking the most effective dosage.
If treatment is successful, the doctor will slowly reduce the dosage if possible to eventually stop the medication. People should not abruptly stop taking Prozac or Zoloft.
via Prozac vs. Zoloft: What are the differences?
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[WEB SITE] The New Compounds That Could Treat Depression in 24-Hours
Posted by Kostas Pantremenos in Depression on July 25, 2015
Current antidepressants take around 3 to 8 weeks to kick in and only help around 50% of people who are depressed.
A new type of antidepressant holds the promise of treating depression quickly, without too many side-effects. Professor Scott Thompson, of the University of Maryland School of Medicine who led the research, said:
“Our results open up a whole new class of potential antidepressant medications.
We have evidence that these compounds can relieve the devastating symptoms of depression in less than one day, and can do so in a way that limits some of the key disadvantages of current approaches.”
Currently used antidepressants, such as Prozac and Lexapro, target levels of the neurotransmitter serotonin.
Unfortunately they are only effective in around half of people with depression. Even amongst people they do help, it can take three to eight weeks for the effects can be felt. For patients who are suicidal, this period can be excruciating.
Also, many now believe that targeting serotonin is not effective (see: Long-Held Belief About Depression Challenged by New Study).
The new compounds focus on another neurotransmitter with the acronym GABA (gamma-aminobutyric acid), instead of serotonin. GABA mainly reduces brain activity in certain key areas related to mood.
The new class of compounds dampen down these inhibitory signals. Theoretically, the result should be to lift mood.
Professor Thompson explained that preliminary tests on animals have been encouraging:
“These compounds produced the most dramatic effects in animal studies that we could have hoped for.
It will now be tremendously exciting to find out whether they produce similar effects in depressed patients.
If these compounds can quickly provide relief of the symptoms of human depression, such as suicidal thinking, it could revolutionize the way patients are treated.”
The study found that the compounds only affected the brains of stressed rats and left unstressed rats unchanged. This may mean that the side-effects of the treatment will be less severe than those seen for current antidepressants.
The study was published in the journal Neuropsychopharmacology (Fischell et al., 2015).
via The New Compounds That Could Treat Depression in 24-Hours.
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[WEB SITE] What if everything we know about treating depression is wrong?
Posted by Kostas Pantremenos in Depression on June 7, 2015
A study is challenging the relationship between depression and an imbalance of serotonin levels in the brain, and brings into doubt how depression has been treated in the U.S. over the past 20 years.
Researchers at the John D. Dingell VA Medical Center and Wayne State University School of Medicine in Detroit have bred mice who cannot produce serotonin in their brains, which should theoretically make them chronically depressed. But researchers instead found that the mice showed no signs of depression, but instead acted aggressively and exhibited compulsive personality traits.
This study backs recent research indicating that selective serotonin reuptake inhibitors, or SSRIs, may not be effective in lifting people out of depression. These commonly used antidepressants such as Prozac, Paxil, Celexa, Zoloft, and Lexapro, are taken by some 10% of the U.S. population and nearly 25% of women between 40 and 60 years of age. More than 350 million people suffer from depression, according to the World Health Organization, and it is the leading cause of disability across the globe.
The study was published in the journal ACS Chemical Neuroscience. Donald Kuhn, the lead author of the study, set out to find what role, if any, serotonin played in depression. To do this, Kuhn and his associates bred mice who lacked the ability to produce serotonin in their brains, and ran a battery of behavioral tests on them. In addition to being compulsive and extremely aggressive, the mice who could not produce serotonin showed no signs of depression-like symptoms. The researchers also found, to their surprise, that under stressful conditions, the serotonin-deficient mice behaved normally.
A subset of the mice who couldn’t produce serotonin were given antidepressant medications and they responded in a similar manner to the drugs as did normal mice. Altogether, the study found that serotonin is not a major player in depression, and science should look elsewhere to identify other factors that might be involved. These results could greatly reshape depression research, the authors say, and shift the focus of the search for depression treatments.
The study joins others in directly challenging the notion that depression is related to lower levels of serotonin in the brain. One study has shown that some two-thirds of those who take SSRIs remain depressed, while another study has even found them clinically insignificant.
Critics of common antidepressants claim they’re not much better than a placebo, yet may still have unwanted side effects.
SSRIs started to become widely used in the 1980s. Their introduction was heralded by the psychiatric community as a new era where safer drugs that directly targeted the causes of depression would become the standard. While SSRIs aren’t more effective than the older antidepressants, such as tricyclics and monoamine oxidase inhibitors, they are less toxic.
An earlier study by the National Institute of Mental Health found that two out of three patients with depression don’t fully recover using modern antidepressants.
These results “are important because previously it was unclear just how effective (or ineffective) antidepressant medications are in patients seeking treatment in real-world settings,” said James Murrough, a research fellow at the Mount Sinai School of Medicine Mood and Anxiety Disorders Program.
via What if everything we know about treating depression is wrong?.
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