Fluoxetine

Fluoxetine is a drug from the class of antidepressants. The active ingredient belongs to the Selective Serotonin Reuptake Inhibitors (SSRI).

What is fluoxetine?

After zimelidine (no longer approved), fluoxetine is the second drug from the generation of selective serotonin reuptake inhibitors (SSRIs). The first patent was awarded to the pharmaceutical company Lilly in 1975. It was launched in the USA in 1988 with the name Prozac. In Germany the drug has been available as Fluctin since 1990.

Selective serotonin reuptake inhibitors such as fluoxetine are used in Germany to treat depression. The drug is also used in the treatment of obsessive-compulsive disorders or bulimia.

One of the most common side effects of the antidepressant is nausea. One fifth of all patients treated with fluoxetine complain of severe nausea. It can also lead to insomnia and severe fatigue.

Pharmacological effect

Fluoxetine inhibits the reuptake of serotonin in the synaptic cleft. Serotonin is a neurotransmitter and a tissue hormone. The substance occurs in the intestinal nervous system, in the central nervous system, in the blood and in the cardiovascular system.

Serotonin fulfills various functions in these organ systems. For example, it relaxes the smooth muscles in the blood vessels or stimulates bowel activity. However, the best-known effect of serotonin is on mood. Serotonin gives a feeling of serenity, contentment and inner calm. A lack of serotonin leads to feelings of anxiety, depression, grief and aggressiveness. Because of this effect, serotonin is popularly known as the happiness hormone.

Depressed and other mentally ill patients often show a pronounced deficiency in serotonin. That is why selective serotonin reuptake inhibitors such as fluoxetine are used. Fluoxetine inhibits the uptake of serotonin from the synaptic cleft. This will prolong the effect of the neurotransmitter that has already been absorbed. Fluoxetine also has a direct effect on the serotonin receptors in the central nervous system. In higher doses, fluoxetine can also inhibit the reuptake of norepinephrine.

Medical application & use

The drug fluoxetine is used to treat obsessive-compulsive disorder and depression. The active ingredient is also used as a drug supplement in the therapy of eating disorders and self-induced vomiting. By increasing the serotonin content in the brain, fluoxetine increases drive in those affected.

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Risks & side effects

The drug fluoxetine must not be used in children under eight years of age. It can be used to treat major depressions in children over eight years of age and in adolescents. It should be noted that fluoxetine can lead to suicidal behavior, especially in younger people. This is the result of the fact that some depressed patients only put imaginary suicidal thoughts into practice through the energy gained from antidepressants. Before that, they didn't have the energy to do it.

Fluoxetine must not be used in acute manic conditions. Patients with mania have an abnormally elevated mood, which would increase further with fluoxetine use. Furthermore, the drug must not be taken together with MAO inhibitors. MAOIs are used to treat depression and Parkinson's. In combination with fluoxetine, serious to fatal side effects can occur. After stopping fluoxetine, patients must wait at least five weeks before being allowed to take an MAOI. Therefore, switching from fluoxetine to an MAO-inhibitor or from an MAO-inhibitor to fluoxetine should only be done under the supervision of a doctor.

Nausea is one of the most common side effects of the drug. More than 20 percent of all patients who take fluoxetine experience nausea. Insomnia is also a common side effect. Other side effects include tiredness and loss of appetite. Anxiety, nervousness, muscle weakness, and muscle tremors are also potential side effects. In particular, anxiety, mania, nervousness and sleep disorders lead to the fact that the treatment with fluoxetine is discontinued by the patients.

Another common side effect of selective serotonin reuptake inhibitors like fluoxetine is a disorder of the libido. Other sexual dysfunction, such as the inability to orgasm, can be side effects of SSRIs.

Some patients develop hives and sometimes severe skin rashes while taking the antidepressant. About a third of patients with these skin conditions discontinue therapy with fluoxetine.

The phenomenon of akathisia (seated unrest) also occurs frequently as a side effect. With akathisia, patients cannot remain still in one position. You are very restless. Akathisia usually occurs immediately after the start of therapy or when the dose is increased. It goes away when treatment is stopped or the dose is reduced.

When fluoxetine is combined with drugs that also affect the serotonin system, the so-called serotonin syndrome can develop. It is a complex of symptoms caused by the accumulation of serotonin in parts of the body. Symptoms of serotonin syndrome include sweating, tremors, and chills. The syndrome can be fatal in some cases. Particular caution is required when combining fluoxetine with MAO inhibitors, tramadol, triptans, lithium, St. John's wort and tryptophan. When fluoxetine is combined with substances such as carbamazepine, haloperidol or tricyclic antidepressants, shifts in blood levels and toxicities can develop.