Just starting on Fluoxetine / Prozac

[hn292]

Hi everyone. I was wondering if you guys might be able to share some of your experiences starting on Fluoxetine / Prozac.

Today was my first day taking it (20 mg) and I am experiencing an overwhelming amount of nausea. Though I haven't vomited as of yet, I don't want to be too far from my bathroom. (Related to my anxiety/depression is my extreme fear of vomiting). The thought of food is too much. I am also experiencing shaking and intense irritability to those around me which is very out of character for me. I also feel weak, but I know that must be stemming from the minimal amount of food i'm consuming.

Another strange thing I am noticing is that I'll be sitting here and feel like I might be hungry physically, but then I think about eating food and the nausea surges again. It is the weirdest thing.

For the sake of context, I also take mirtazapine and lorazepam. (the Lorazepam is more for instances of acute anxiety)

Will this continue? I haven't felt this sick in awhile and it is so debilitating. I feel like I can't do anything.

Any help or advice is appreciated. xx


(As a side note I want to say that I see both a licensed therapist and a prescriber but I wanted the opinions of people who have actually taken this medication.)

[panic_down_under]

Hi everyone.

Welcome to No More Panic, :welcome:


Today was my first day taking it (20 mg) and I am experiencing an overwhelming amount of nausea. Though I haven't vomited as of yet, I don't want to be too far from my bathroom. (Related to my anxiety/depression is my extreme fear of vomiting).

Firstly, the recommended starting dose for those with anxiety/panic is 10mg to limit the initial surge in anxiety produced by increased serotonin activity.

Nausea may be both a direct affect of the med, and also from an increase in anxiety. It is a common anxiety symptom.

One of the problems with serotonergic antidepressants such as fluoxetine is that serotonin isn't only a brain neurotransmitter. It has a number of roles in most organs and the brain is actually only a minor user. The enteric nervous system (http://www.scientificamerican.com/article/gut-second-brain/), the mini brain which controls the gut makes and uses about 50 times more serotonin than the brain and can initially be more affected by SSRIs than the brain is.

Both organs usually adapt to these meds by reducing serotonin synthesis and expression within a few weeks and the side-effects begin to diminish. Until they do common over-the-counter remedies for nausea, etc, should help.


Another strange thing I am noticing is that I'll be sitting here and feel like I might be hungry physically, but then I think about eating food and the nausea surges again. It is the weirdest thing.

This too will pass. It take at least a month for reasonably fit adults to starve to death, most take longer, so you're in no immediate danger, and you will probably soon regain any weight lost, plus maybe add a few pounds. It is just one of the 'joys' of taking antidepressants.


For the sake of context, I also take mirtazapine and lorazepam. (the Lorazepam is more for instances of acute anxiety)

Another common initial SSRI side-effect is insomnia. Mirtazapine can be an effective sleeping pill (though, imho, immediate-release trazodone (Desyrel) is better), and it has a pretty good track record for easing SSRI induced sexual-dysfunction too.

However, the use of lorazepam is more problematic as there is good evidence benzodiazepines significantly reduce the effectiveness of antidepressants by blocking hippocampal neurogenesis which is what produces their therapeutic response (see: Boldrini M (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4374628/), 2014; Nochi R (https://www.ncbi.nlm.nih.gov/pubmed/23963779), 2013; Sun Y (https://www.ncbi.nlm.nih.gov/pubmed/23639432), 2013; Wu X (http://www.biologicalpsychiatryjournal.com/article/S0006-3223(09)00106-1/abstract), 2009; Stefovska VG (https://www.ncbi.nlm.nih.gov/pubmed/18991352), 2008).

In light of these studies benzodiazepines use should probably be limited to a couple of weeks when first taking antidepressants just to ease the initial anxiety surge, for a while after AD dose increases for the same reason and thereafter only for occasional breakthrough anxiety.