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This article was co-authored by Padam Bhatia, MD. Dr. Padam Bhatia is a board certified Psychiatrist who runs Elevate Psychiatry, based in Miami, Florida. He specializes in treating patients with a combination of traditional medicine and evidence-based holistic therapies. He also specializes in electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS), compassionate use, and complementary and alternative medicine (CAM). Dr. Bhatia is a diplomat of the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association (FAPA). He received an MD from Sidney Kimmel Medical College and has served as the chief resident in adult psychiatry at Zucker Hillside Hospital in New York.
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Prozac, or fluoxetine, is an antidepressant in a class known as selective serotonin reuptake inhibitors (SSRIs). This class of medications are the most commonly prescribed antidepressants.[1] Prozac can be prescribed to treat several conditions, such as depression, panic attacks, obsessive compulsive disorder, bulimia nervosa, and premenstrual dysphoric disorder.[2] It is most commonly prescribed to treat depression. Because Prozac affects your brain chemistry, it should never be stopped without consulting your doctor. Discontinuing any prescription medication should only take place under your doctor’s supervision. If your doctor does recommend that you stop taking Prozac, follow the steps below. The length of time it takes to completely stop taking Prozac may depend on how long you were on the medication, the dosage you were prescribed, the condition you are being treated for, and other medications you may be taking.
Steps
Learn how Prozac works. Prozac works by inhibiting how receptors in your brain reabsorb (or “reuptake”) the neurotransmitter serotonin. Serotonin is a naturally occurring chemical “messenger” (neurotransmitter) that helps maintain mood balance. Research suggests that a deficit of serotonin is a contributing factor in clinical depression.[3] Prozac helps keep your receptors from reabsorbing too much serotonin, thereby increasing the amount available to your body.[4]- Prozac is an SSRI because it’s “selective.” It seems to primarily operate on serotonin and not any of the other neurotransmitters that are also partially responsible for mood.[5]
Consider your side effects. Prozac can cause some side effects. Many of these will be mild or go away after four to five weeks. You should talk with your doctor if you have severe side effects or symptoms, or if they do not go away. Possible side effects include:[6]- Nervousness
- Nausea
- Dry mouth
- Sore throat
- Drowsiness
- Weakness
- Uncontrollable shaking
- Loss of appetite
- Weight loss
- Changes in sex drive or function
- Excessive sweating
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Recognize emergency side effects. In some cases, Prozac may cause side effects that must be attended to immediately. Prozac has been known to increase the likelihood of suicidal thoughts, especially in people under the age of 24. If you experience thoughts about or consider plans to harm or kill yourself, seek immediate medical attention.[7] You should also call your doctor immediately if you experience any of the following symptoms:- New or worsening depression
- Extreme feelings of worry, agitation, or panic
- Aggressive behavior or irritability
- Acting without thinking
- Severe restlessness
- Feelings of frenzied, abnormal excitement
Think about whether Prozac is controlling your symptoms. Prozac is generally an effective antidepressant for most people. However, it may not work with every person’s brain, or neurochemistry. If you continue to experience any of the following after taking Prozac, talk with your doctor. These could be signs that your depression or disorder is not being adequately managed by the medication.[8]- You are experiencing severe or continuous side effects (mentioned above)
- You continue to feel loss of interest in pleasurable activities or hobbies
- Your fatigue does not improve
- Your sleep is disturbed (insomnia, excessive sleeping)
- You continue to have difficulty concentrating
- You experience changes in appetite
- You experience physical aches and pains
Understand the dangers of discontinuing antidepressants. Because antidepressants alter your brain chemistry, discontinuing them without medical supervision can cause serious symptoms.[9]- Longer-acting medications, such as Prozac, usually have fewer discontinuation symptoms. However, you may still experience side effects such as:
- Nausea, vomiting, diarrhea, or cramping
- Sleep issues, such as insomnia or nightmares
- Balance issues, such as dizziness or lightheadedness
- Sensory or movement issues, such as numbness, tingling, tremors, and lack of physical coordination
- Feelings of irritability, agitation, or anxiety
- Antidepressants need to be discontinued slowly over a period of time by gradually reducing the dose. This is known as “tapering.” Tapering can take weeks or months, depending on the antidepressant, how long you have taken it, your dosage, and your symptoms. Your doctor will determine the best way for you to taper Prozac.
- You may experience a relapse of depressive symptoms once you have stopped taking Prozac. To distinguish between discontinuation symptoms and a relapse, think about when the symptoms start, how long they last, and what type they are.
- Discontinuation symptoms usually develop quickly. They will usually improve over one to two weeks. They will often include more physical complaints, such as nausea or aches and pains.
- Relapse symptoms gradually develop after two to three weeks. They generally worsen over two to four weeks. If any symptom continues to last more than a month, consult your doctor.
- Longer-acting medications, such as Prozac, usually have fewer discontinuation symptoms. However, you may still experience side effects such as:
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Ask your doctor why you are taking Prozac. Because Prozac can be prescribed for several different conditions, you should ask your doctor why she has prescribed Prozac for you.[10] S/he may be able to recommend a different medication for your condition.- In some cases, your doctor may recommend that you stop taking Prozac if she feels that you are no longer at risk for (or no longer have) chronic or recurrent depression. If your doctor recommends this, it will usually occur after you have taken the medication for at least six to 12 months.[11]
Discuss with your doctor your reasons for wanting to stop taking Prozac. Inform your doctor about any severe, continuing side effects from Prozac. If you have been taking Prozac for longer than eight weeks and do not feel like it is helping with your disorder, explain the symptoms you are continuing to see. This information will help your doctor make an informed decision and decide if the time is right to stop taking Prozac.[12]
Ask your doctor to go over your discontinuation process with you. It’s crucial to understand and follow your doctor’s recommendations exactly. Depending on how long you have been taking Prozac and its dosage, your doctor may or may not choose to taper your medication. Follow your doctor’s instructions to the letter to avoid serious side effects.[13]- Prozac usually has fewer issues with discontinuation symptoms because it has a long “half-life.” Half-life refers to the time it takes your body to reduce the concentration of the drug by one half.[14] A longer half-life such as Prozac’s means that the drug stays in your body longer. This means that the drug concentration in your body will not suddenly decrease, and this leads to fewer discontinuation symptoms.
- If you have been on Prozac for a short period of time, such as six to 12 weeks, or are on a small maintenance dose (e.g., 20mg a day), your doctor may not recommend tapering your dose.
- Keep track of your tapering schedule. Write down the date and the dosage you took each day. This will help you ensure that you’re following your doctor’s orders.
Document any effects you experience as a result of discontinuation. Even if you are tapering Prozac, it is still possible to experience discontinuation symptoms, such as those mentioned elsewhere in this article. Talk with your doctor if you develop any discontinuation or other unusual symptoms.- Remember that your depression may reoccur as you discontinue your medication. Keep your doctor informed about how you are feeling. If you have concerns about a relapse, consult your doctor for advice.
- Keep your doctor informed of your progress whether or not you experience any symptoms. Your doctor will monitor you for at least a few months after discontinuation.
Take new prescriptions appropriately. Your doctor may prescribe a different medication to control your depression or disorder. Be sure to take it as recommended by your doctor.[15]- Your doctor’s recommendations will include your own preference, prior response to medication, effectiveness, safety and tolerability, cost, side effects, and drug interactions with other medications you are taking.
- If Prozac did not adequately control your depression, your doctor may recommend a medication in the same class of SSRIs, such as Zoloft (sertraline), Paxil (paroxetine), Celexa (citalopram), or Lexapro (escitalopram).
- Other classes of medication the doctor may try if you experienced side effects or inadequate control of your depression include:
- Serotonin Norepinephrine Reuptake Inhibitors (SNRIs) such as Effexor (venlafaxine)
- Tricyclic Antidepressants (TCAs) such as Elavil (amitriptyline)
- Aminoketone Antidepressants such as Wellbutrin (bupropion)
Consider psychotherapy. Several studies show that people who see a therapist while discontinuing their antidepressant are less likely to have a depression relapse.[16] Therapy can help you learn to deal with unhealthy thoughts and behaviors. It will give you tools to manage your stress, anxiety, and responses to life. There are many different types of therapy, and treatment plans will depend on your individual situation. Your doctor may be able to recommend a therapist in your area.[17][18]- Cognitive Behavioral Therapy (CBT) has a strong record of effectively managing depression. Its goal is to help you learn to think more positively and challenge negative thoughts and behaviors. A cognitive-behavioral therapist will help you identify unhelpful thinking habits and change inaccurate beliefs. These can help reduce depressive symptoms.
- Other therapies include interpersonal therapy, which focuses on improving communication patterns; family therapy, which helps resolve family conflicts and improve family communication; or psychodynamic therapy, which focuses on helping the person gain self-awareness.
- You may need to try a few types of therapy (or a few therapists) before you find one that suits you best.
Consider acupuncture. Although it is not part of the official guideline recommendations for discontinuing medications or treating depression, acupuncture may be useful for some people.[19] Acupuncture is a technique that inserts thin needles into various areas of the body to relieve symptoms. It should only be done by a trained, licensed practitioner. Consult your doctor if you are considering acupuncture. Your doctor may be able to recommend an acupuncturist. Acupuncture may not be appropriate for everyone.- One study suggests that electroacupuncture, which runs a mild electric current through acupuncture needles, is as effective as Prozac in reducing depressive symptoms, and may even work faster.[20]
- The National Certification Commission for Acupuncture and Oriental Medicine is the licensing organization for acupuncturists in the US. You can use their “Find a Practitioner” feature on their website to locate a certified acupuncturist near you.
- Keep your doctor informed about any acupuncture or alternative treatments you undergo. This information should be kept in your medical records. All your health care practitioners should work together to ensure you get the best care.
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Eat well. No diet has been shown to relieve or “cure” depression. However, eating a healthy, well-balanced diet will provide your body the nutrients it needs to help fight illness. Eat a diet that incorporates fresh fruits and vegetables, complex carbohydrates, and lean protein.[21][22]- Avoid heavily processed foods, refined sugars, and “empty” calories. These provide very few nutrients for the amount of calories you consume, which can leave you feeling hungry. They can also cause swings in blood sugar, which can affect mood.[23]
- Eating foods high in B12 and folate may help regulate your mood. Liver, chicken, and fish are good sources of B12. Beets, lentils, almonds, spinach, and liver contain folate.[24]
- Foods high in selenium may help with depressive symptoms. Good sources include Brazil nuts, cod fish, walnuts, and poultry.
- Foods that are high in tryptophan can be converted by your body into serotonin when combined with vitamin B6. Tryptophan-rich foods include soybeans, cashews, chicken breast, salmon, and oats.
- Studies suggest that regularly consuming omega-3 fatty acids may help regulate your mood. Flaxseed or canola oil, walnuts, kale, spinach, and fatty fish such as salmon are good sources of omega-3s. Oils such as corn, soybean, and sunflower are not as high in omega-3s.[25]
- You should check with your doctor before taking omega-3 supplements, as they may worsen some chronic illnesses. Dosage between one and nine grams daily may be helpful to improve mood.[26]
Make non-drug-related changes. "I reduced the amount of Prozac I was taking to 10mg from 20mg. After four weeks of lowering my dose, I began to feel a little anxious, though I had very few other side effects. This reminded me of all of the non-drug-related choices I can make that may help me adjust more easily. Implementing them really helped!" - Betsi K.
Make small lifestyle changes. "When I stopped Prozac for the second time, this article helped me tackle the various aspects of setting myself up for success. Diet, exercise, medical care, meditation, and getting sunlight were all great things to focus on while reducing medication. This set me on the right path." - Denise C.
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Limit alcohol consumption. Alcoholic beverages should usually not be consumed while taking antidepressants. Even if you do not take antidepressants, watch your alcohol intake. It is a depressant and excessive alcohol can deplete serotonin.[27]- Heavy consumption of alcohol is also associated with anxiety and panic attacks.
- A “drink” usually refers to a 12-ounce beer, 5-ounce glass of wine, or 1.5-ounce shot of hard liquor. The Centers for Disease Control and Prevention recommend no more than one drink per day for women and two drinks per day for men. This is considered “moderate” drinking.[28]
- 3Exercise regularly. Studies show that regular, moderate exercise — at least 30-35 minutes a day — boosts your body’s natural “feel-good” chemicals (endorphins). Exercise may also stimulate neurotransmitters such as norepinephrine. These may help relieve depressive symptoms.[29][30]
- Regular exercise can improve mood in people who have mild to moderate depression. It can also be used as a support in treating severe depression. However, if you continue to experience depressive symptoms even with regular exercise, you should contact your doctor.[31]
Follow a sleep schedule. Your sleep can often be disturbed by depression. It’s important to follow good “sleep hygiene” to ensure that your body is rested. Good hygiene steps include:[32]- Going to bed and getting up at the same time each day (even weekends).
- Avoiding stimulation before sleeping. Activities such as exercise and things involving screens, such as TV or computer work, can disrupt your sleep patterns.
- Avoiding alcohol and caffeine before bed. Even though alcohol may make you feel sleepy, it can disrupt REM sleep.[33]
- Keeping your bed for sleep. Don’t do work in bed.
Get some sun. Some types of depression, such as seasonal affective disorder, may benefit from getting exposure to sunlight. Research suggests that exposure to sunlight may affect your serotonin levels.[34] A lack of sunlight may also increase your body’s production of melatonin, which can cause depressive symptoms.- If you cannot get natural sunlight, consider purchasing a light therapy box. Talk with your doctor about what box will best suit your needs. Generally, it’s recommended that you use your light therapy box for at least 30 minutes every morning.[35]
- If you are going outside for sunshine, make sure to wear sunscreen with an SPF of at least 15. Choose a “broad-spectrum” sunscreen.
Strengthen your support systems. Keep a close relative or friend involved in the discontinuation process. She or he may be able to help provide emotional support or recognize signs of relapse. Tell this person about side effects or symptoms to watch out for.[36]- Throughout the discontinuation process, stay in touch with your doctor. Let him or her know about your status, feelings or symptoms.
Try meditation. A Johns Hopkins review of studies suggests that 30 minutes of meditation daily may reduce symptoms of depression and anxiety.[37][38]- Mindfulness meditation has received significant scientific study and is well-supported for reducing depression and anxiety.[39] “Mindfulness-Based Stress Reduction” (MBSR) is a common type of training that may help.[40]
- Meditation usually includes the following elements:[41][42]
- Focus: Focusing on a specific object, image, mantra, or breathing
- Relaxed breathing: Slow, deep, even breathing increases oxygen and reduces stress hormones
- Quiet setting: Eliminating distractions
- You can download several guided meditations online. MIT has relaxation and mindfulness meditation MP3s.[43] The UCLA Mindful Awareness Research Center has downloadable or streaming audio guides for meditation.[44]
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Expert Q&A
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- QuestionWhy can't you just stop taking a medication like Prozac?
Padam Bhatia, MDDr. Padam Bhatia is a board certified Psychiatrist who runs Elevate Psychiatry, based in Miami, Florida. He specializes in treating patients with a combination of traditional medicine and evidence-based holistic therapies. He also specializes in electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS), compassionate use, and complementary and alternative medicine (CAM). Dr. Bhatia is a diplomat of the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association (FAPA). He received an MD from Sidney Kimmel Medical College and has served as the chief resident in adult psychiatry at Zucker Hillside Hospital in New York.
Board Certified PsychiatristIf you just abruptly stop taking any psychiatric medication, you increase the likelihood of discontinuation syndrome, which can be extremely unpleasant. It isn't necessarily physically dangerous, but the experience can be pretty nasty. You'll be much happier if you work with your psychiatrist or doctor to taper your way off of the medication.
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Tips
- Make it a point to eat well, exercise regularly and get enough sleep while reducing Prozac. These healthy lifestyle choices will help you feel your best while you are reducing the medication.Thanks
- If withdrawal symptoms do develop, contact your doctor.Thanks
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Warnings
- If symptoms of depression worsen while tapering Prozac, immediately consult your doctor.Thanks
- Do not change your tapering schedule without discussing it first with your doctor.Thanks
- Never stop taking Prozac without first consulting your doctor.Thanks
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References
- ↑ http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
- ↑ http://www.webmd.com/drugs/2/drug-6997/prozac-oral/details
- ↑ http://www.medicalnewstoday.com/articles/232248.php
- ↑ http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
- ↑ http://www.mayoclinic.org/diseases-conditions/depression/in-depth/ssris/art-20044825
- ↑ http://www.nlm.nih.gov/medlineplus/druginfo/meds/a689006.html
- ↑ http://www.nlm.nih.gov/medlineplus/druginfo/meds/a689006.html
- ↑ www.nimh.nih.gov/health/publications/depression/index.shtml?ct=399994
- ↑ Padam Bhatia, MD. Board Certified Psychiatrist. Expert Interview. 3 April 2020.
- ↑ http://www.nlm.nih.gov/medlineplus/druginfo/meds/a689006.html
- ↑ http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
- ↑ Padam Bhatia, MD. Board Certified Psychiatrist. Expert Interview. 3 April 2020.
- ↑ Padam Bhatia, MD. Board Certified Psychiatrist. Expert Interview. 3 April 2020.
- ↑ http://www.medscape.com/viewarticle/448250_3
- ↑ http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
- ↑ http://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants
- ↑ http://www.nimh.nih.gov/health/topics/psychotherapies/index.shtml
- ↑ http://www.mayoclinic.org/tests-procedures/psychotherapy/basics/what-you-can-expect/prc-20013335
- ↑ http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
- ↑ http://www.scientificamerican.com/article/can-acupuncture-treat-depression/
- ↑ http://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
- ↑ http://www.webmd.com/depression/guide/diet-recovery
- ↑ https://www.psychologytoday.com/blog/your-genetic-destiny/201410/diet-and-depression
- ↑ https://www.psychologytoday.com/blog/your-genetic-destiny/201410/diet-and-depression
- ↑ http://www.webmd.com/depression/features/fish-oil-to-treat-depression
- ↑ http://www.webmd.com/depression/features/fish-oil-to-treat-depression?page=2
- ↑ https://www.psychologytoday.com/blog/your-genetic-destiny/201410/diet-and-depression
- ↑ http://www.cdc.gov/alcohol/faqs.htm
- ↑ http://www.mayoclinic.org/diseases-conditions/depression/in-depth/depression-and-exercise/art-20046495
- ↑ http://www.health.harvard.edu/mind-and-mood/exercise-and-depression-report-excerpt
- ↑ http://www.health.harvard.edu/mind-and-mood/exercise-and-depression-report-excerpt
- ↑ http://sleepfoundation.org/ask-the-expert/sleep-hygiene
- ↑ https://www.drinkaware.co.uk/check-the-facts/health-effects-of-alcohol/effects-on-the-body/alcohol-and-sleep
- ↑ http://www.healthline.com/health/depression/benefits-sunlight#1
- ↑ http://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/in-depth/seasonal-affective-disorder-treatment/art-20048298
- ↑ http://www.health.harvard.edu/diseases-and-conditions/going-off-antidepressants
- ↑ http://www.hopkinsmedicine.org/news/media/releases/meditation_for_anxiety_and_depression
- ↑ http://archinte.jamanetwork.com/article.aspx?articleid=1809754
- ↑ http://archinte.jamanetwork.com/article.aspx?articleid=1809754
- ↑ http://www.npr.org/blogs/health/2014/01/07/260470831/mindfulness-meditation-can-help-relieve-anxiety-and-depression
- ↑ http://www.helpguide.org/harvard/benefits-of-mindfulness.htm
- ↑ http://www.mayoclinic.org/tests-procedures/meditation/in-depth/meditation/art-20045858?pg=2
- ↑ https://medical.mit.edu/community/stress-reduction
- ↑ http://marc.ucla.edu/body.cfm?id=22
About This Article
Board Certified Psychiatrist
This article was co-authored by Padam Bhatia, MD. Dr. Padam Bhatia is a board certified Psychiatrist who runs Elevate Psychiatry, based in Miami, Florida. He specializes in treating patients with a combination of traditional medicine and evidence-based holistic therapies. He also specializes in electroconvulsive therapy (ECT), Transcranial Magnetic Stimulation (TMS), compassionate use, and complementary and alternative medicine (CAM). Dr. Bhatia is a diplomat of the American Board of Psychiatry and Neurology and a Fellow of the American Psychiatric Association (FAPA). He received an MD from Sidney Kimmel Medical College and has served as the chief resident in adult psychiatry at Zucker Hillside Hospital in New York. This article has been viewed 288,102 times.
Co-authors: 10
Updated: December 19, 2023
Views: 288,102
Categories: Antidepressants
Medical Disclaimer
The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.
Article SummaryX
If you want to stop taking Prozac, consider whether the medication is controlling your symptoms and note any unpleasant side effects that you're experiencing. Next, talk to your doctor about why you want to stop taking Prozac and discuss an alternative treatment plan, which may include introducing a new medication. Then, follow your doctor's instructions for tapering your Prozac dosage gradually, since it's dangerous to stop taking it suddenly. Be sure to contact your doctor if you experience any unexpected or severe symptoms as you taper off of Prozac. To learn about other medications that may help you manage depression, read on!
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