Afraid to start Prozac due to a supposed arrhythmia

[Deepseathree]

So I’ve been on and off Prozac for years and I’m about to fall back into the on category. But I’m kind of weary to start as there might be an arrhythmia.

I’ve had heart palpitations before due to mainly lack of sleep, but recently I’ve started having some in the gym which I’ve never had in over 15 years of lifting basically.

I’m not dehydrated and I’m not exactly having bouts of anxiety. I’ve been much worse before than I am now. I’ve had two ekgs which showed fine, but was referred to a Cardiologist who is giving me a halter monitor and a stress echo.

I had Covid at the end of May and have been out of the gym basically since then due to fatigue. But I’ve finally felt good enough to go back and have been maybe 5 times. 2 or 3 of those times is when I had the palps. So now I’m worried it’s an arrhythmia. Which leads me to worry about starting Prozac.

[panic_down_under]

I’ve had heart palpitations before due to mainly lack of sleep, but recently I’ve started having some in the gym which I’ve never had in over 15 years of lifting basically.

Palpitations are not necessarily an indicator for heart arrhythmias. Palpitations are very common and more so for those with anxiety and/or depression.

I’m not dehydrated and I’m not exactly having bouts of anxiety. I’ve been much worse before than I am now.

So why are you thinking about going back onto fluoxetine?

I had Covid at the end of May ...

So now I’m worried it’s an arrhythmia. Which leads me to worry about starting Prozac.

There is good evidence that Covid can trigger arrhythmias, but as per above palpitations are not necessarily a good indicator for them. Nor would arrhythmia necessarily rule out the use of fluoxetine. With the possible exception of citalopram (Celexa) and escitalopram (Lexapro) the SSRIs do not significantly impact arrhythmias and as mild anticoagulants they can reduce the risk of heart attack and ischaemic stroke (but may slightly increase that of the less common haemorrhagic stroke).

[Deepseathree]

I’ve had them before due to certain instigators. Mainly being lack of sleep. Other than that, I’ve never really had them except for as a side effect of Trazadone.

I’m at a point in life where I realize that I’m better off with them at the moment. I don’t suffer panic attacks anymore or anything of that nature. It’s just the constant feeling of being uptight that I feel isn’t normal. It’s normal for me, but I know it’s not how I should feel. So I’m jumping back on as it’s one I’ve been off and on the most and that I feel I tolerate the best.

I want to start Prozac, but I’m worried about starting if this is an arrhythmia. Though it’s not even known if it is.

[panic_down_under]

I’m at a point in life where I realize that I’m better off with them at the moment. I don’t suffer panic attacks anymore or anything of that nature. It’s just the constant feeling of being uptight that I feel isn’t normal. It’s normal for me, but I know it’s not how I should feel.

Did the feelings of being uptight diminish when you were last on fluoxetine?

So I’m jumping back on as it’s one I’ve been off and on the most and that I feel I tolerate the best.

Going on and off ADs may not be wise as there is good evidence that their effectiveness may drop significantly each time they are discontinued and restarted eventually leading to poop-out [1].

I want to start Prozac, but I’m worried about starting if this is an arrhythmia. Though it’s not even known if it is.

Have you discussed this with your doctor or psychiatrist? If so, what was their thoughts?

[1]
Amsterdam JD, 2016 and Amsterdam JD, 2009, found the likelihood of antidepressants working after each restart drops by between 19-25% (see also: Bosman RC, 2018; Amsterdam JD, 2009; Leykin Y, 2007).