Fluoxetine - Chris Aiken, MD

Q: Depression

Fluoxetine use based on FDA approval in major depressive disorder. SSRI side effects reviewed with patient.

Q: Anxiety Disorder

Fluoxetine use based on controlled trials in anxiety disorders (Generalized Anxiety Disorder, Panic Disorder, and Social Anxiety Disorder; it is FDA approved in Panic Disorder). SSRI side effects reviewed with patient.

Q: PTSD

Fluoxetine use based on controlled trials in Posttraumatic Stress Disorder (Hoskins M et al, Br J Psychiatry 2015;206(2):93–100). SSRI side effects reviewed with patient.

Q: OCD

Fluoxetine use based on FDA approval in OCD. SSRI side effects reviewed with patient.

Q: Bulimia

Fluoxetine use based on FDA approval in bulimia. SSRI side effects reviewed with patient.

Q: Binge Eating

Fluoxetine use based on controlled trials in binge eating disorder. SSRI side effects reviewed with patient.

Q: Premenstrual Syndrome

Fluoxetine use based on FDA approval in Premenstrual Syndrome. SSRI side effects reviewed with patient.

Fluoxetine (Prozac)

SSRI antidepressant

Major Depression (age 8+)²
Best SSRI for Children
Generalized anxiety, Panic, Social Anxiety¹
PTSD¹

OCD (age 7+)¹
Bulimia¹
Binge Eating¹
Borderline²

Features

Child-Studied, Generic, Medication, Weight-Free, Child-Approved, Tolerable, Non-controlled

Handout

Dosing

Depression (20-40 mg/d), Anxiety disorders (40-60 mg/d), PTSD (20-40 mg/d), Bulimia (60 mg/d), Binge eating (40-60 mg/d), Borderline PD (20-60 mg/d), OCD (60-80 mg/d).

CHILD MDD: >8 years: 10-20 mg po qd, initially; Start at 10 mg/day in lower weight children, may gradually increase dose after 1 week; not to exceed 20 mg qd.

CHILD OCD: >7 years: 10 mg po qd, initially; may gradually increase dose after 2 weeks to 20 mg qd; further increases may be considered after several weeks; Adolescents and higher-weight children: Typical dosage range 20-60 mg qd; Lower-weight children: Typical dosage range 20- 30 mg qd.

INTERACTIONS: Raises lots of drug levels by inhibiting CYP 2D6, 3A4, 2C9, 2C19, 2B6.

Management

Best antidepressant in child depression. Long half-life (lasts up to a month after stopping it, so lower WD risk than other SSRIs). Less weight gain than other SSRIs (short term has weight loss). Combined with olanzapine in unipolar and bipolar depression.

TOLERABILITY: Apathy, sexual dysfunction, sleep disruption, nausea, restless legs, akathisia, sweating, yawning, withdrawal syndrome.

RISKS: Suicidality in age < 25, mania, osteopenia in post-menopausal women, increased bleeding, hyponatremia (mainly in elderly).