Key Takeaways
- Prozac is used to treat bipolar disorder but must be taken with another drug called Zyprexa.
- Prozac can cause side effects, like nausea, dizziness, and headaches, that you should tell your doctor about if they persist.
- Prozac has a warning because it may increase suicidal thoughts in children and young adults.
As useful as Prozac can be in treating these conditions, the drug may cause side effects ranging in severity from mild to life-threatening. Moreover, people who take Prozac may experience withdrawal symptoms if the treatment is not tapered off appropriately.
For Anxiety Disorders
Prozac is commonly used to treat anxiety disorders, many of which can co-exist with bipolar disorder. These include generalized anxiety disorder (GAD), social anxiety disorder (SAD), panic disorder (PD), and post-traumatic stress disorder (PTSD)
In fact, a 2015 review of studies published in EBioMedicine concluded that the lifetime risk of an anxiety disorder co-occurring with bipolar disorder was 42.7%.
Within the context of bipolar disorder, Prozac is considered the only antidepressant with a formal indication in treating bipolar depression but only when used in combination with the antipsychotic drug Zyprexa (olanzapine).
Antidepressants need to be used with caution in bipolar disorder, as there is some evidence that they can trigger mania and worsen cycling of the disorder.
On the downside, the concomitant use of Prozac and Zyprexa also increases the risk of side effects.
Recommended Dosages
There is a fixed-dose combination drug called Symbyax which combines Prozac and Zyprexa in a convenient capsule formulation. Approved for adults in 2009 and children in 2013, Symbyax is usually prescribed at a lower dose and gradually increased until the depression symptoms resolve.
Ultimately, the aim of bipolar depression treatment is to alleviate symptoms at the lowest possible dose to reduce the risk of side effects.
Common Side Effects
Side effects are not uncommon when taking Prozac. Some are mild and transient and will often resolve as your body gradually adapts to the medication.
Side effects of Prozac may include:
- Abdominal cramps and bloating
- Abnormal dreams
- Anxiety
- Constipation
- Diarrhea
- Dizziness or lightheadedness
- Drowsiness
- Dry mouth
- Sexual side effects
- Headaches
- Increased sweating
- Insomnia
- Loss of appetite
- Low libido
- Nausea and vomiting
- Tremors
- Weakness
Call your doctor if any of these side effects persist or worsen.
Drug Hypersensitivity
Some adverse reactions to Prozac may be serious and require emergency medical treatment. This is especially true if there are signs of a potentially life-threatening allergic response known as anaphylaxis.
Call 911 or seek immediate emergency care if you experience some or all of the following symptoms:
- Rash or hives
- Fever
- Facial swelling
- Swelling of the tongue and/or throat
- Trouble breathing
- Difficulty swallowing
- Disorientation and confusion
- Nausea and vomiting
- Rapid heart rate
- Fainting
- A feeling of impending doom
If left untreated, anaphylaxis can lead to shock, coma, respiratory or heart failure, and death.
Black Box Warning
Prozac and other antidepressants can increase suicidal thoughts or actions in some children, teenagers, or young adults. This usually occurs within the first few months of starting treatment or when the dose is changed. Call your doctor immediately if you notice any sudden or severe changes in mood, behavior, thoughts, or feelings.
Withdrawal Symptoms
Although withdrawal is more common with shorter half-life antidepressants like Paxil (paroxetine) or Zoloft (sertraline), it can occasionally happen with the longer half-life Prozac, especially if you have been on treatment for a long time. SSRI withdrawal is rarely dangerous, but it can be extremely uncomfortable and distressing.
Symptoms typically include:
- Dizziness
- Extreme anxiety
- Fatigue
- Headaches
- Malaise
- Nausea and vomiting
- Profuse sweating
- Vertigo
- Headaches
- Weakness
If the decision is made to stop Prozac, you would need to taper down slowly. Your doctor can provide specific instructions as well as the appropriate dosage pills.
Never stop taking Prozac without first speaking with your doctor and working out a dosage reduction plan. Stopping treatment abruptly can lead to a form of drug withdrawal known as SSRI discontinuation syndrome.
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Additional Reading
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Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ. 2016;352:i65. doi:10.1136/bmj.i65
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Silva MT, Zimmermann IR, Galvao TF, Pereira MG. Olanzapine plus fluoxetine for bipolar disorder: a systematic review and meta-analysis. J Affect Disord. 2013;146(3):310-8. doi:10.1016/j.jad.2012.11.001
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