Prozac Review: The Best SSRI?

Prozac Review: The Best SSRI?


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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.

Prozac is an antidepressant that's been approved by the FDA since 1987. The generic version of the drug is called fluoxetine, and we’ll use these terms interchangeably throughout this article because they refer to the same active drug ingredient.

But is Prozac proven to be effective at relieving depression symptoms? How does it compare to newer-generation antidepressants? Does it cause side effects? And how do patients rate and describe the effects of Prozac?

In this article we'll answer all of these questions and more, as we review clinical studies on Prozac to determine if it's safe and effective for treating depression.

We'll document side effects of the drug, compare its efficacy to other antidepressants, explain if the generic version is as effective, and feature unsponsored patient ratings.

Does Prozac Cure Depression?

Prozac is FDA-approved to treat a number of mental health conditions including obsessive compulsive disorder (OCD) and panic disorder, but it's typically prescribed to treat depression.

A medical review published in the Annals of General Hospital Psychiatry journal examined data on Prozac for depression from 87 clinical trials and 9,087 patients.

Prozac reduced depression scores to a statistically significant degree after just one week of treatment, and reduced depression scores by an average of 38% after three weeks of treatment.

A 2020 meta-study found that Prozac was similarly effective for treating major depressive disorder (MDD) in children and adolescents.

A 1997 clinical trial analyzed whether Prozac was effective for treating depression in patients who were unresponsive to sertraline, which is another leading antidepressant.

63% of patients who failed initial treatment with sertraline were responsive to Prozac, which means that this percentage of patients experienced partial or full remission of depression symptoms while taking Prozac.

We will conclude from the available research that Prozac is effective for treating depression, which is unsurprising as the medication is approved by the FDA for that indication.

Does Prozac Cause Side Effects?

Prozac black box warning

Prozac does cause side effects in some patients.

Prozac's manufacturer is required by the FDA to publish a "black box" warning, shown above, on the drug's product label indicating that Prozac may increase the risk of suicidal thoughts and behaviors in young adults, adolescents and children.

Given this warning, it may be advisable for young adults and guardians of children to speak with their doctor about alternative antidepressants that do not have this risk, especially for those with a personal or family history of suicidal thoughts.

A medical review on the side effects of Prozac found that the most common side effects are nausea, increased nerves and insomnia.

The study authors showed that these side effects were actually more common in Prozac patients than in patients taking another class of antidepressants called tricyclic antidepressants. An example of a brand-name tricyclic antidepressant is Elavil.

Real People Try Prozac

One of the most popular YouTube reviews on Prozac is published by a creator named Gabby Oglesby, who discusses the benefits and side effects she experienced:

A YouTube creator with a mental-health-focused channel called "Lifting Out of the Lows" shared his experience taking Prozac:

Does Prozac Cause Weight Gain?

Some prescription antidepressants are associated with weight gain, so patients are often concerned about whether Prozac will have this effect.

meta-study on antidepressants and weight gain reported that Prozac was associated with an average weight gain of 4.63 pounds over two years.

However, it's challenging to determine if this weight gain was caused by Prozac, given that many adults in developed countries gain weight throughout middle age.

A separate study on antidepressants and body weight published in The Journal of Clinical Psychiatry actually found Prozac to be associated with weight loss, and to have much more favorable effects on weight than other antidepressants.

Overall, it seems to us that the data on Prozac and weight gain is inconclusive, which may make the drug a superior option for overweight and obese patients, given that some antidepressant medications are conclusively associated with significant weight gain.

Patients Rate Prozac

Drugs.com is a website that allows prescription medication patients to rate and review the drugs they're taking.

We cannot verify the accuracy or authenticity of any reviews on this site.

Prozac has been reviewed over 1,000 times on Drugs.com, and currently has a 7/10 rating for treating depression.

A top positive review is written by a user named "READTHISPLEASE" who gave the drug a 10/10 rating, and claims it's been highly effective:

"My only regret is having wasted and missed on so many things because of my pride against anti depressants and self-pity attitude . Hang in there, you got this. > 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."

A top negative review comes from a user named "Mcano" who gave the drug a 1/10 rating, and claims it caused weight gain and other side effects:

"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. I want to sue. Dr said I would not gain and probably lose weight."

Is the Generic Version Better?

The generic form of Prozac is called fluoxetine, and as described earlier in this article, these two terms refer to the exact same active chemical compound.

Patients are often curious about whether the generic version is as effective as Prozac.

medical review on generic versus branded drugs, published in the PLOS Medicine journal, found generic drugs to be just as safe and effective as their brand name counterparts. This suggests that fluoxetine is just as effective as Prozac, and may be cheaper.

The retail price of Prozac is around $450 at the time of updating this article, according to GoodRx.

The retail price of fluoxetine is under $7 at Cost Plus Drugs.

We would recommend that patients interested in Prozac speak with their doctor about generic fluoxetine instead.

Can I Drink Alcohol on Prozac?

Prozac's FDA label states "Do not drink alcohol while using Prozac."

There’s some interesting research in regard to Prozac’s effect on alcohol consumption and desire to drink.

clinical trial with an alcoholic patient population found that Prozac decreased desire to drink when the subjects were presented with a variety of alcoholic drinks. 

Prozac at a daily dose of 60 milligrams (mg) per day decreased alcoholic drinks consumed by nearly 50%.

These results were replicated in a clinical trial published in the Archives Of General Psychiatry journal.

The above-linked trial found that depressed and alcoholic patients taking Prozac experienced an improvement in depression scores and also decreased their alcohol intake throughout the course of the trial.

In patients who are able to refrain from alcohol use while taking Prozac, it appears that the medication may reduce their desire to drink which can have health benefits.

However, since the drug manufacturer clearly states that alcohol should not be consumed at all while taking Prozac, it's important that patients have an open and honest discussion with their doctor about their alcohol intake and whether they will be able to refrain entirely from drinking while using the medication.

If a patient is unable to refrain from alcohol use while on Prozac, their doctor can prescribe them a different antidepressant without a negative interaction with alcohol.

Prozac vs. Zoloft

Zoloft (generic name sertraline) is another commonly-prescribed antidepressant, so patients are often curious about which is more effective for treating depression.

We highlighted in a previously-cited research review that Prozac is shown to be effective in patients who are unresponsive to Zoloft, but there are also studies directly comparing the efficacy and safety of the two drugs.

A 2003 comparative study analyzed results from five clinical trials on Prozac and Zoloft for treating major depression.

Zoloft was found to be more effective on average for treating depression, and was more effective to a statistically significant degree for treating severe depression. 88% of patients with severe depression experienced symptom reduction on Zoloft compared to only 71% on Prozac.

Based on the studies that we can find, we would recommend that patients speak with their doctor about Zoloft rather than Prozac.

Our Mental Wellness Recommendation

Brightside Health is our top online therapy pick, as this platform connects patients with licensed therapists and doctors from the comfort of their home.

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. 

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 at the time of updating this article.

Interested patients can check out Brightside at this link to the brand's official website.

Prozac Dosage

A 2022 medical review documents that Prozac dosage is typically initiated at 20 mg, and the effective dosing range is between 20 mg and 80 mg daily.

The drug can be broken into smaller doses taken throughout the day to minimize the risk of side effects.

A patient prone to nervousness may want to take 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 side effects.

Typically, a doctor will prescribe the lowest dose in the effective range to test the patient's response.

If the patient responds to the drug at a lower dose, they may remain at that dose. If the patient is unresponsive at 20 mg, their doctor may slowly increase their dose over the course of weeks until they experience benefits from the drug.

How Does Prozac Work?

Prozac is a selective serotonin reuptake inhibitor (SSRI), which is the most common class of antidepressant medication.

These drugs minimize the reuptake of serotonin in the brain, which delays its biological processing and causes artificially increased levels.

Since serotonin is a neurotransmitter that influences mood and motivation, artificially increasing its circulating levels can help depressed patients feel better.

Researchers still haven’t conclusively proven 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 in depressed patients.

Stay up-to-date on our research reviews

Conclusion

Prozac is clinically proven to be effective for treating depression, although it may be slightly less effective than another commonly-prescribed antidepressant called Zoloft.

The most common side effects of Prozac treatment are relatively mild, including nervousness and insomnia, but the drug may increase the risk of suicidal thoughts and actions in young adults, adolescents and children.

For patients considering Prozac, it seems logical to ask your doctor about generic fluoxetine instead, as it should be just as effective as Prozac but can be significantly cheaper (especially for those without health insurance).

Fluoxetine has a retail price under $7 on Cost Plus Drugs at the time of updating this article.

Prozac does not appear to be associated with weight gain in clinical research, which may make the drug a healthier alternative to other antidepressants in patients with obesity or certain pre-existing conditions.