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    Fluoxetine Use
    An_244458 posted:
    I am a 56 year old American living and working in Bahrain. I have seeing a psychiatrist, whose credentials are out of Ireland, for about 3 years now. She prescribed fluoxetine for my depression at 20 mg per day, calling them "serious happy pills." I don't know about the "happy" but they have been of tremendous benefit in controlling my anger/rage responses. My question is this: Are the changes in brain chemistry effected by the fluoxetine temporary in nature? Can this medication effect permanent changes in my brain chemistry or must I continue taking this medication for the rest of my life? If so, what, if any, are the long-term effects of this medication? Thank you!
    Anneinside responded:
    These questions probably need to be answered by a doctor. I would suggest you repost this and in the title put "Dr. G" so you can catch is attention. Also, do you have bipolar or unipolar depression?
    Joseph F Goldberg, MD responded:
    Dear An,

    Prozac, like all antidepressants, is not known to cause permanent changes in the brain, so much as to improve the efficiency of nerve cell functioning and compensate for what we think is a deficit. Antidepressants aren't happy pills -- they treat depression in people who have a depression. The best analogies would be to blood pressure medicines that restore normal blood pressure in people with hypertension, or Tylenol for a fever in people who have a temperature (Tylenol lowers a high fever when it is present, but in people with no fever, it does not drop body temperature below its set point). Sometimes we also use the analogy of a cast for a broken arm, which, if left in place for a long enough time, lets the bone heal. Taking away a blood pressure medicine may cause hypertension to recur, taking away Tylenol may cause a fever to come back, and taking away an antidepressant too soon may cause depression to come back (like removing a cast before the bone has had a chance to heal). How long to stay on an antidepressant when it is having a benefit is sometimes hard to judge. In someone who has had a clear-cut first lifetime episode of a full major depression (with all the symptoms of clinical depression, including poor sleep, low energy, trouble concentration, etc.), the usual recommendation is to leave the "cast" on (the medicine) for 6-9 months and then possibly consider removing it to see how things are. In someone who has had multiple lifetime episodes of major depression, or chronic depression (where it has been present for 2 years or longer without a break) longer (sometimes indefinite) is usually recommended. In people who have bipolar disorder, there is more debate about how long to keep an antidepressant in the picture after a benefit is seen. Some authorities advise getting rid of antidepressants as soon as the depression clears up; others advocate keeping an antidepressant going for a year or even longer if the response has been dramatic and it is causing no problem. In people who don't have clear-cut bipolar disorder, or clear-cut full episodes, but may nevertheless have mood swings or strong anger or rage responses to life situations, SSRIs like fluoxetine can help to curb the intensity of emotionality, and in those situations, the benefit may continue for as long as someone elects to continue taking the medicine, which could be indefinitely under supervision of a doctor.

    - Dr. G.
    bipoet001 responded:
    I think if any professional referred to my medications as "serious happy pill", I'd immediately questions their credentials. To see this type of attitude toward antidepressants expressed this way by a paid professional, really shows why all types of depression are not taken seriously as an actual disease by layman. I would hope you'd find a more knowledgable doctor for your personal care. David

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