After successful results with Prozac (Fluoxetine), there comes a time when the physician should reassess the patient and determine if the drug should be discontinued. Abruptly stopping the treatment can have a devastating effect, so it is important that patients follow a well thought out plan of discontinuation and gradual withdrawal.
Patients who suffer from obsessive compulsive disorder (OCD), bulimia, premenstrual dysphoric disorder (PDD), or anxiety may be prescribed Prozac for a short period of time. After a few weeks or perhaps months, the drug can be discontinued since the disorder may have been minimized or even eliminated. Patients who are taking Prozac to alleviate symptoms of clinical depression or dysthymia may need to take Prozac for years or even for the rest of their lives. These differences in disorders will partially dictate the method selected by a physician for withdrawing Prozac.
Long Term Dependence
Clinical studies on Prozac that evaluate long term tolerance of the drug or physical dependence have not been done. The length of treatment, or the duration of Prozac use has also not been studied. But these same factors are important if a patient is to stop taking Prozac. It may be more difficult to stop taking Prozac if it has been taken over the course of several years, as opposed to several weeks or months.
Since it is not known how long Prozac treatment should be continued, physicians are advised to conduct periodic reassessments of their patients to determine if the need for treatment is still present. The literature and drug fact sheets however do not explain how to do that. Common sense would dictate that in order to find out if Prozac is still needed to control symptoms of depression, the drug should be discontinued. After that, a “wait and see” period would pass and if symptoms of depression begin again the patient should resume taking Prozac.
Prozac Withdrawal Symptoms
Discontinuing treatment with Prozac is not as simple as taking the “wait and see” approach. The manner in which a patient discontinues the drug is dependent upon several factors, including how long the patient has been taking Prozac. One constant is known about all patients-Prozac should never be discontinued abruptly. The best method for discontinuation of the drug is a slow, methodical decrease, over a period of time. If a patient abruptly stops taking Prozac, he or she could experience the following withdrawal symptoms:
- severe headache
- burning or tingling sensations around the body
Neurological symptoms are also commonly reported by patients and they are described as "brain zaps", "brain shocks", "brain shivers" or "brain zings". These symptoms may occur both when the drug is discontinued abruptly or when the dosage is significantly reduced.
Planning to Discontinue Prozac
Blood tests show that Prozac (fluoxetine hydrochloride) stays in the body longer than other SSRI’s. Factors such as an individual’s dosage and their unique metabolism play a role in determining just how long that time is. Since Prozac remains in the body up to 5 weeks after discontinuation it may take several months of gradual lessening of the dose before total withdrawal of the drug is complete. For example, if taking a 40 mg daily dose, a decrease to 30 mg for several weeks, then a decrease to 20 mg for several weeks, and so on. Anyone who is discontinuing use of Prozac should be under a doctor’s care and supervision.
Prozac withdrawal may never be an issue in patients who suffer from clinical depression since they may never stop taking it. But in those who need to stop taking Prozac it is necessary to have a plan, developed in consultation with a physician, in order to avoid the unpleasant side effects of withdrawal.