Prozac (fluoxetine)

My psychiatrist did not want to give me any antidepressants because of the possibility that they could trigger a full manic episode. So far I have had only hypomanic episodes and only once came close to being manic. But once was enough. That episode sufficiently terrified me that I was willing to go along with my psych about not taking antidepressants.

However, after the last five weeks of depression I finally gave in and asked if I could be prescribed an antidepressant. After some arguing, in which I said that I cannot pull myself out of depression on my own and that I had never been able to do so in the last three years, my psychiatrist reluctantly agreed to give me a prescription.

The factors that tipped the decision were my ability to stabilise my hypomania (I can recognise the very early signs of hypomania and use non-drug methods to effectively control it) and the extraordinary speed with which I react to antimanic drugs (Tegretol takes effect in 30-40 minutes).

My psychiatrist figured that basically I would be able to detect the early warnings of an impending manic episode and be able to take drugs to stop it in its tracks, or at least slow it down enough that I would be able to get to a safe place or contact her. The prescription was not happily given - I was still asked if I wanted to take Prozac along with Haldol (haloperidol), a tranquilising agent. But I wanted to see the effect of Prozac on its own - it helps later on in trying to disentangle the effects of drug combinations - so I passed up on the Haldol for now. I agreed with my psychiatrist that we could add in Haldol later if I needed it.

Prozac is supposed to take effect in 3-10 days. However, with my usual drug sensitivity, the effect kicked in early, within two hours in fact. So how did it feel.

I felt light, as if the air was made of something thinner than air, or as if I had been wading through water all the time and now was walking on dry land or as if I had had weights on my hands and legs and had just taken them off.

Everything was easier to do. It was different from being hypomanic. When I am hypomanic I have lots of ideas on things to do and lots of energy to do it with. With the Prozac my energy didn't increase and I didn't have the urge to do everything. Rather, I carried on no different than before, but everything I wanted to do was possible. Basically what the brain told my body to do, my body did without resisting or being sluggish about it, as is typical in depression.

I felt light.

If I had to translate this into medical terms I would say that depression usually slowed down or inhibited my psychomotor functions and Prozac removed the inhibitions and let my body respond properly to my mind's direction.

This was not a mental perception - the effect continued into the following morning 14 hours later. I got up in the morning and did all those things that I would usually not do (make the bed, wash dishes, shave) on a morning. It was so surprising that C. noticed the difference and told me that the Prozac was probably kicking in. And I could feel the difference. No so much that Prozac was adding energy or direction, but more that it was removing barriers. There really was no inhibition that is so common with trying to do basic things when I am depressed.

This feeling of normality was also qualitatively different from being on Tegretol. Tegretol brings me off my hypomania, makes me calmer and brings me down to something approaching normal. However Tegretol seems to create a link directly between what I am thinking and my actions - I think of something and I act on it. There is always the sensation that the Tegretol is sitting on my shoulder like a guardian angel and pointing me in the correct direction to do the correct things. It is wonderfully effective, but the it does get heavy having someone on your shoulder all the time.

The Prozac seems to dissolve my sluggishness. I can think better. With depression, I have a difficult time holding together complex ideas or schedules that have many pieces. With the Prozac, I can cope with these thoughts. More than that, manipulating ideas is not inhibited - I can look at an idea in different ways or think about how I want to reschedule the rest of the day without becoming stuck.

Prozac itself doesn't make me feel happier, regardless of the hype. What I am though is delighted that I can actually function normally. Any happiness I get is the usual satisfaction of achieving things. However this compares dramatically to the frustration that depression causes when I can't get things done. There is a world of a difference between the two.

The effect of the Prozac started wearing out after 20 hours. This is not supposed to happen. Blame either my peculiar metabolism or the fact that I may be on the very edge of a working dosage so that the daily dips in the Prozac level in my body drops me below an effective dose. Who knows? But I'm beginning to feel a bit as if I am sluggish again.

After a few weeks of slipping into mild depression but no mania, I am beginning to realise that Prozac has two effects. The first one is that it dampens my cycles - I don't get as depressed as I used to do, but I don't stop cycling. It means that the depressions are milder, which I find useful, but I don't actually stop being depressed. The second thing is that it has stopped all of my manic symptoms. That is not supposed to happen with an antidepressant, but that is how it works with me. Go figure.

As a result I have increased my dosage to two 20 mg tablets, one in the morning and one in the afternoon. Of all the drug combinations this has worked best with me.

I've also been having mild headaches since I started taking Prozac. The headaches are very mild and can often be forgotten in daily activities, but they don't seem to quite go away. The headaches are not a bad tradeoff for a productive day. And I could always take Advil or Tylenol if I wanted.

However, I have found out that if I let the Prozac wear off (it takes 24 - 36 hours with my 100 mg / day dosage), I get very bad headaches, and feel very very nauseous. It's pretty bad and it is definitely something to avoid.

On a related issue, I have also found out why Eli Lily and Co., the maker of Prozac, has labelled each of the pills "Mon," "Tue," etc. I have found out that I don't usually forget to check to take my tablets. What I forget is whether I have taken the tablet today or not. The times I don't take my regular dosage usually happens because I thought I had taken them earlier in the day (obviously I don't use those convenient labels). Recommendation - definitely take your tablets on the days that match the labels. You'll save yourself some confusion and probably a nasty bout of headaches and nausea.

One person has written to say that they are forgetting a lot of things. This hasn't been my experience, but I wonder if it could indicate that the Prozac is causing mild mania, and it's attendant memory problems. It also fit in with the person's feeling happy as well as their improved sex life.

My sinuses have also acted up slightly. Like the headaches, the effect is quite mild but noticeable. The result is that my sinuses seem to be draining more frequently resulting in the disconcerting sensation that I am having a nosebleed (no bleeding occurs at all), and that I am more stuffed up at night so I snore more - C. has complained. Ah well, nothing comes for free. I eventually checked with a doctor and was told that Prozac does tend to make your nose stuffy.

I also tend to have a dry mouth - or at least a medicinal taste in my mouth. It doesn't really bother me since all of the medications leave a medicinal taste in my mouth and I've gotten used to them.

At the higher dosage (20 mg, twice a day), I have also noticed that my eyes tend to blur slightly for short periods of time, usually when I am changing focus from near to far objects (or vice versa). The effect doesn't last for more than a few seconds and has no real impact except to scare me a little. I did get my eyes checked and was told that Prozac does cause blurred vision - however, as long as it isn't much of a real nuisance I can ignore it.

Alcohol and Prozac react very badly. I almost inevitably get nauseous when I drink alcohol. The effect is inconsistent - sometimes all it takes is half a beer for me to feel sick and sometimes it may take two glasses of wine. However it seems that the emptier my stomach or the stronger the alcohol, the faster I feel nauseous. The nausea remains for at least two hours and I have decided that much as I like wine, I don't like it enough to put up with feeling ill. I now drink mostly soda water.

I also tend to eat less when I am on Prozac. It's actually reached the point where I have to think about eating - I hardly ever get hungry. I like it because it works great for getting rid of my excess pounds, but I worry that I might not be getting enough vitamins and minerals. The effect fades with time though.

I have been told that I toss and turn more in bed, but I don't find that that translates into any difference in the quality of sleep for me. I have marginally more trouble getting to sleep, but that has translated to my taking about two minutes to fall asleep rather than thirty seconds, not any kind of problem at all. I also seem to awaken a bit more easily, but again it doesn't seem to impose any problems.

Apparently, Prozac can also cause sleepless nights or wake you up very early, particularly if it is taken on evenings or nights. It hasn't happened to me, but I have had that effect with other antidepressants. When this has happened, I have taken the tablets in the mornings or around 5-6 pm instead.

Since I have started on the Prozac, my body temperature seems to have risen slightly. At the very least my hands and feet are warmer than when I was depressed. This doesn't seem to be an effect of the Prozac itself. C. and I have noticed that when I am hypomanic I seem to radiate more heat than when I am depressed (I've never read of this effect anywhere and I am trying to document it). But we both take my apparent warmth as a sign that the Prozac is making a difference.

The Prozac does seem to work but it does not work fully. As a result the net effect is that I still cycle, but my depression is milder and I spend less time overall depressed. Since the Prozac on the whole leaves me feeling better than I was before, then it's a step in the right direction. Prozac does have side effects which may be problematic. I've decided to accept them, but for anyone, it would be a decision to balance whether the side effects are a good price to pay for how they are feeling and what they can now do.

Regardless, because of Prozac's potential to trigger a manic episode, I will follow my psych's advice and keep Tegretol (or any other antimanic drug such as Depakote or Lithium) on hand in case I go very manic.

WP 3 likes, 2 comments

When I am on a High Dose of Prozac

Warning

A high dose of Prozac works for me, but my reaction to drugs is not typical. I do NOT recommend this to anyone. If you think a high dose of Prozac might work for you, please consult with your psychiatrist before trying it. In addition, please monitor your moods carefully for the first 2-3 weeks to make sure that you do not become manic.

31 Dec 2001

Since the 6 Dec 2001, I started taking 40 mg Prozac in the morning, 20 mg in the afternoon around 5:30 pm, and 20 mg at night just before going to sleep. This is a dramatic increase in dosage but I had just come off a rather nasty bout of depression lasting about four weeks and I decided that I wanted something that would keep me from getting depressed. I figured that a high dose of Prozac would do that.

I knew that there was a possibility of triggering a manic mood. However, my hypomania is under reasonable control and I have drugs that can calm my manic moods in about half hour , so it was reasonably safe to go for a high dose. It was a bit of a risk, but I figured that not being depressed was an outcome worth taking a risk for.

The results are a bit peculiar and not stated in any literature I've found so far.

First off, a high dose of Prozac stops my rapid cycling. Just stops it. I no longer get a week of hypomania and a week of depression. In fact I don't get any mood swings at all. I've stabilised so completely that the minor fluctuations in mood are similar to (or perhaps less than) the regular mood changes in a normal person.

There isn't much to be said any further. Without having to deal with my mood swings and the constant fight to control them, my productivity and functionality has soared. It's incredible how low much lower my capabilities were with the mood swings. Little things around the house are now getting done. My parents and friends are noticing a reliable, calm person emerge. I can actually organise a schedule and keep to it. Wow.

I have not become a superman and I haven't become hyper. I'm not overreaching my abilities and I am not superefficient. I'm just your everyday plain John Doe with no mood swings. It's mind boggling how much a normal person can get done without being manic.

Of course taking so much Prozac is not without its problems. When I first started up with the high dosage, my vision blurred enough that I couldn't read my computer monitor. It didn't make much difference while doing everyday things, but it still worried me. Luckily, after about a week the blurriness disappeared and I was left with my normal vision (well, apparently so. I haven't done any rigorous testing since).

I also stopped eating. I'm serious. The desire to eat simply disappeared and I would go for 8-10 hours without food, then look and dinner and think "I don't really feel like eating." It is not as if I don't get hungry - I do - but that doesn't translate into actually wanting to eat. So far, this is a mixed blessing. On the one hand I've managed to lose about 12 pounds since the beginning of December, for which I am thrilled (about 12 more to go). On the other hand, it's really easy to become malnourished because I really don't feel like eating. I've had to be very careful to make myself eat salads, fruits and vegetables. It's not that I don't like them, it's just that I don't feel like eating them, same as everything else.

I think this is what is meant by anorexia and I consider it serious enough to reconsider this dose of Prozac. But not before I lose the next 12 pounds.

The lack of food craving has actually brought one fact to the forefront - I don't like sugar. That was never apparent given my chocolate and cake cravings while depressed, but now chocolate or ice cream leaves a burning sweet sensation in my mouth that I don't like.

The high dosage of Prozac makes me feel slightly nauseous sometimes. There seems to be no pattern to the nausea, although it seems to happen frequently after I've eaten, which certainly doesn't add any encouragement for me to eat. The nausea is mostly mild so I can ignore it, but it is there. I also get the "medicinal" taste in my mouth - but that has never bothered me.

I've also been feeling cold. This has been hard to document because December is the coldest month that we have (temperatures drop to 20°C, brr!), and because a weight loss of twelve pounds may have affected the amount of insulation (i.e. fat) that I am carrying. On the other hand, I have been feeling cold in office since I started taking the high dosage of Prozac. Nobody else in office feels this way and I've taken to wearing a sweater there. Outside of office I find that I feel cold on mornings and nights, which never used to happen before, and I need a warm blanket when I'm sleeping. Although it is not a major problem, I do have to keep it in mind - for example, I now carry a sweater to the cinema with me.

Being cold also presents a self-monitoring problem. One of my signs that I am going hypomanic is that my muscles tense up. It has been a reliable signal in the past, but now when I am feeling cold my muscles tense up. I'm having quite a bit of difficulty trying to determine if I am tense because I am hypomanic or because I'm cold. I'm going to have to recalibrate my self monitoring system.

The feeling of coldness may be related to the sensation that my skin is warmer, as if I am radiating more heat. I'm not certain if this is because my metabolic rate has increased or if the blood circulation in my skin has increased. This radiation of heat is typical to what I get when I am hypomanic, but I don't show other signs of hypomania. Of course if I am radiating more heat, it may partially explain why I'm feeling colder.

The combination of warmer skin and feeling cold matches the description of "fever" which is listed as one of the side effects of Prozac. But it doesn't feel like fever to me - it feels like two independent effects that can happen either together or separately from each other.

Another of the side effects that may or may not be beneficial has been that I sleep substantially less than I used to. These days if I go to sleep at 11:00 pm, I will be wide awake by 5:30 am. If I go to bed earlier, I'll get up earlier. I know this is because I take 20 mg of Prozac when I am going to sleep, but so far this has not been a problem - I usually answer e-mail or go jogging once I wake up. I don't feel as if I have missed any sleep and I feel rested. However, I worry that I may in fact not be getting enough sleep, particularly since I've started feeling tired by nine o'clock most nights. But that may be caused by the exercise that I am now doing (all that early morning jogging), or it may simply be a side effect of the Christmas season - I've been out for dinner nearly every evening since the holiday season started. For the moment, as with the weight loss, I'm simply going to monitor what is happening and either adjust my dose of Prozac or stop taking it late at nights if the sleep pattern gets too silly.

There is one advantage of taking Prozac at nights even though it might be interfering with my sleeping - it does allow me to start off the day. One of the more annoying problems I have had is that I am slow on mornings - it is difficult to wake up properly, organise my morning schedule, and overcome the feeling that perhaps it would be better if I stayed at home. I'd usually arrive to work late. Since I've been taking the Prozac at night though, I've been able to get going on mornings without difficulties. It's telling that the one day that I forgot to take my medication at night, I did not get to work on time.

I've also been a bit worried about my energy level. Now that I am sleeping less and eating less, I should be tired more of the time. This hasn't been the case. My energy levels have remained the same and I've had no difficulty going jogging or cycling. If anything, I feel a bit more alert and perky than before.

Speaking of perky, my sex life has gone the way of my desire for food. I still like sex and being cuddled and kissed and foreplay is as pleasurable as it ever was. But getting and sustaining an erection has become a sometimeish thing, and sometimes the effort in reaching to the point of orgasm feels more like a chore than fun. Sometimes I just don't bother.

This hasn't been as much of a problem as you might think, as C. and I had been separated until yesterday. But now that we have made up, I'm going to see if our sex life is adversely affected. So far, my desire for C. has overcome the nullifying effects of the Prozac and I haven't had any problems, but that may not last. I hope that if there are problems I will deal with it with grace, elegance, and humour.

For the record. I'd much rather have no sex life than mood swings. So for me the trade off is acceptable so far. That may be subject to change in the future, but right now I'd rather be stable. Gives you an idea how much I don't like the mood swings, doesn't it.