Disclaimer: None of the information in this article constitutes medical advice, and is just the opinion of the writer(s). We recommend that patients follow their doctor’s guidance in regard to prescription medication.
Fluoxetine, also referred to as fluoxetine hydrochloride or fluoxetine HCL for short, is a prescription drug approved by the FDA for the treatment of depression. It’s the generic version of the drug Prozac, as we outlined in our Prozac reviews article.
But is fluoxetine as effective as Prozac? How much can it really reduce depression scores? Does it cause concerning side effects? Does it cause side effects in women specifically? And how do real users describe effects of the drug?
In this article we’ll answer all of these questions and more as we review clinical studies on fluoxetine to determine if it's safe and effective, document its side effects, explain whether the drug interacts with alcohol and share real, unsponsored user reviews of fluoxetine.
Does Fluoxetine Reduce Depression?
Fluoxetine has been studied in hundreds of clinical trials involving depressed patients.
A 2004 medical review documented that fluoxetine reduced depression severity after just one week of treatment, and decreased depression scores by an average of 38% after three weeks of treatment. This review involved data from nearly 10,000 patients.
A clinical trial on fluoxetine published in the BMC Psychiatry journal examined the drug's efficacy for treating major depressive disorder (MDD) in postmenopausal women. After eight weeks of treatment, fluoxetine reduced depression scores by around 50% on average. There was clinically significant improvement after just one week.
An extensive meta-study on the effectiveness of 21 antidepressants found that fluoxetine was effective on average, but was one of the least effective medications studied.
Overall we will conclude that fluoxetine is effective for reducing symptoms of depression, but may not be as effective as other leading antidepressants.
Fluoxetine Side Effects
SSRI drugs do cause side effects in some patients, and fluoxetine is no exception.
A meta-study of the side effects of fluoxetine found that the most common side effects were nausea, nervousness and insomnia. The study authors found that these side effects were actually more common in patients taking fluoxetine than those taking a different class of antidepressants called tricyclic antidepressants.
This suggests that patients with anxiety or insomnia disorders may wish to speak with their doctor about tricyclic antidepressants instead of fluoxetine.
Fluoxetine's FDA label indicates that the drug may increase risk of suicidal thoughts and behaviors in young adults, adolescents and children.
Increased risk of suicidality will not affect most fluoxetine users; it’s a rare side effect, however this side effect is so concerning that it may benefit young adult patients or guardians of adolescents to speak with their doctor about alternative antidepressants that do not confer this risk.
The FDA reserves black box warnings for side effects that may be life-threatening, and this is the most severe category of warning issued by the FDA.
Real, Unsponsored User Review of Fluoxetine
One of the most popular YouTube reviews of fluoxetine comes from a channel called "The Better Side of Life." The creator shares her experience after one year of using fluoxetine, explaining benefits and side effects:
Fluoxetine Side Effects in Females
Women are often curious if there are any drug-specific side effects for them, given that some antidepressants are documented to cause side effects for women specifically.
A medical review published in the Journal of Sex & Marital Therapy found that fewer women (13.4%) reported a worsening of sexual function on the drug than men (17.4%).
We are unable to locate any other medical studies documenting a sex-based difference in side effects to fluoxetine, so we will conclude that there does not appear to be any side effects of this drug specific to females, and women may even respond better to the drug than men based on early research.
Is Brand Name Fluoxetine More Effective?
Prozac is the branded version of fluoxetine.
We would recommend that patients speak with their doctor about fluoxetine rather than Prozac. Since both drugs contain the same active chemical compound, it seems logical to take the generic version which tends to be cheaper. This is an especially important consideration for patients without health insurance.
A medical review compared the efficacy and safety of branded and generic drugs, analyzing data from over 1 million patients. Generic drugs were found to be just as effective as brand name drugs on average. This suggests that generic fluoxetine is as effective as Prozac.
According to SingleCare, the average retail price of Prozac is currently $620.37 while fluoxetine is available for $3.20 on Cost Plus Drugs (Mark Cuban's venture).
Does Fluoxteine Interact With Alcohol?
Fluoxetine's label indicates that users of the drug should avoid alcohol entirely.
There’s also some interesting clinical research in regard to how fluoxetine can decrease the desire to drink alcohol.
A clinical trial on an alcoholic patient population found that fluoxetine decreased the desire to drink. The trial participants were presented with a variety of alcoholic beverages, and showed a decreased desire to drink any of them compared with the placebo group. Fluoxetine at a dose of 60 milligrams (mg) per day decreased alcoholic drinks consumed by around 50%.
These results were mirrored in a separate clinical trial which found that depressed alcoholic patients taking fluoxetine had improvement in depression scores and also decreased their alcohol intake throughout the course of the trial.
Fluoxetine appears to have a negative interaction with alcohol according to the drug's manufacturer, so it's imperative that patients have an honest conversation with their doctor about their alcohol intake and whether they will be able to avoid alcohol entirely while using this drug.
The good news is that fluoxetine appears to decrease the desire to drink, so for patients that are able to avoid alcohol during their first few weeks on the medication, they may lose the desire to drink entirely which can be beneficial for health.
Fluoxetine Dosage
StatPearls, which is a free medical database maintained by the National Institutes of Health (NIH), documents that fluoxetine dosage typically starts at 20 mg per day. It can be broken into smaller doses taken throughout the day to minimize side effects.
A patient prone to anxiety may start on a 10 mg dose in the morning and a 10 mg dose in the evening rather than one single 20 mg dose to decrease the risk of acute side effects.
Fluoxetine has been studied, and proven safe on average, at doses up to 80 mg daily according to StatPearls. Typically a doctor will increase the dosage up to the safety limit if the patient isn’t responding to treatment. If a patient isn’t experiencing any benefit at 80 mg per day, they should probably speak with their doctor about alternate antidepressants.
Fluoxetine Vs. Fluvoxamine
Fluvoxamine is another generic SSRI antidepressant, so patients are often curious about which drug is more safe and effective.
A medical trial published in 2003 directly compared the effectiveness of these two drugs for treating major depression. Depressed patients were given one of the two drugs for 6 weeks, and researchers tracked changes in their depression scores using the Hamilton Depression Rating Scale (HAMD), which is a clinical tool for depression tracking.
The study authors found that there was no difference in efficacy. Both drugs decreased depression to a statistically significant degree. Fluvoxamine took a shorter duration of time to be effective, so it may be a better option for patients suffering from a severe, acute depressive episode.
How Does Fluoxetine Work?
Fluoxetine is a member of a class of pharmaceutical drugs called selective serotonin reuptake inhibitors (SSRI). This is the most common type of antidepressant.
As we documented in our Celexa reviews article on another popular SSRI drug, this class of drugs minimizes the reuptake of serotonin in the brain. This artificially increases circulating serotonin levels. Serotonin is a neurotransmitter that influences mood and depression, so by increasing its levels it may normalize brain function in patients suffering from depression.
Researchers still haven’t conclusively shown that low levels of serotonin in the brain are the cause of depression; we just know that this type of drug is effective on average for depressed patients.
Our Mental Wellness Recommendation
We recommend a platform called Brightside to patients on a mental health journey. It's an online therapy and medication platform that connects patients with licensed therapists and doctors from the comfort of their home.
A medical review published in the Clinical Psychology & Psychotherapy journal found that online therapy was equally effective to in-person therapy for treating depression, anxiety and PTSD. Therapy may be a good first option for patients who want to avoid the side effects of medication.
Brightside also can connect patients with licensed psychiatrists that can prescribe medication. Some patients choose only therapy, some choose only medication, and some choose both. The brand reports that 86% of members feel significantly better within 12 weeks of treatment.
Patients with and without health insurance can use Brightside. For many patients with health insurance, treatment is entirely covered by insurance.
The cost for medication without health insurance is capped at $95/month and the cost for therapy without health insurance is capped at $299/month.
Interested patients can check out Brightside at this link to the brand's website.
User Reviews of Fluoxetine
Fluoxetine has an average rating of 7/10 on Drugs.com for treating depression, which is a relatively high score. This is a website that allows users of prescription medication to share their experience and rate the drug(s) they're taking.
The top positive review of the drug comes from a user named “READTHISPLEASE” who claims that the drug caused a significant improvement in their mental state:
“ONE YEAR AGO I WAS YOU READING THIS COMMENTS THINKING IT WOULD NEVER GET BETTER. WELL IT GOT PRETTY DAMN BETTER. (: God bless whoever is reading this.”
The top negative review of fluoxetine is from a user called “Mc” who claims the drug caused them to gain weight:
“Caused uncontrollable massive weight gain just like the atypical antipsychotics do (129 to 185 in 3 months!!! Eating same diet. Robot emotions. Hair loss. And suddenly...good old diabetes 2.”
